Monday, April 16, 2012

do not harm patients with over reach from new bills

There was an article in the Herald-Leader about a week ago which I actually mostly agreed with. The op-ed stated that the Kentucky state legislature must be sure not to over-reach with new bills aimed at battling the plague of prescription pill abuse in KY and make life for illegitimate patients that receive prescription painkillers and other controlled substances that are the favorite of those that abuse these medications. Two bills sought to make the use of Kentucky's prescription tracking program, KASPAR, mandatory for all doctors that prescribe medications that are deemed controlled substances. This includes not only opiate based or synthetic pain medication, but anti-anxiety medications, such as Xanax and Valium, and medications that contain stimulants, like ADHD medications, Aderal and Ritalin. While this state does have a prescription drug abuse problem we can not throw real patients that are suffering everyday from illness that require these medications under the bus in the name of stopping people from getting high. The current restrictions already placed on these medication cause great difficulty for actual patients that need them. When KASPAR was introduced years ago it did some good, but as I say "Junkies will always find a way,". People started going to states that had weak laws regulating prescriptions, primarily where "pill mills" sprung up all over the state to meet the demand of people from out of state seeking Oxycontin, morphine, Xanax, etc. At one point some counties in Florida had more "pill mills" that McDonald's. It has only been recently that Florida cracked down on these quack doctors and their shady operations. While this has helped stem the flow of illegal pills getting into our state it hasn't got to the roots of the problem. We need to battle addiction with rehab not prison time. Junkies can get whatever drug they want in prison and many share needles which has resulted in enormous rises in AIDS, Hepatitis, and many other incurable diseases. It cost less to pay for 90 days of rehab and AA and NA are free, but it cost a fortune to keep someone in jail for years, where they have access to AA, but are surrounded by narcotics. These people are suffering from the disease of addiction, but are not receiving the detox, rehabilitation, and subsequent support that it takes to get someone off of drugs. Many addicts come out of prison worse than they were before they went in and we are flushing our taxes down the toilet by putting people that are charged with possession and/ or trafficking charges. You can be charged with trafficking for just one pill. Most of these people are not the drug dealing stereotypes that they are made out to be. The people that are the real big money making type are not junkies that sell small amounts to pay for their own addiction. I am all for punishing the people that profit of the suffering of others, but if it can be demonstrated that a person caught selling small quantities of pills are doing so to pay for their own addiction then we need to focus on ending the addiction and the dealing will end on its own. Most of these people stopped getting "high" long ago and are only continuing to use addictive pills to avoid suffering the ravages of narcotic withdraw. I know first hand what this nightmare is like due to the strict laws that limit my access to medications that are needed to cope with my daily, chronic pain. Another result of these laws has been a rise in heroin use in KY. Now that the prescription pills are harder to get the cost on the street of them has dramatically increase and so has crimes, such as, pharmacy robberies and violent crimes committed by addicts that are increasingly desperate. If we had greater access to rehab as opposed to lengthy prison sentences many addicts would take the opportunity to get clean and rid themselves of the hell that is opiate addiction and the hell of withdraw that drives them to cheat, lie, and steal from anyone including family and friends. I have had doctors move away or retire and I have been discharged for violating the finely tuned contracts that most doctors that prescribe pain medicine require their patients to sign. These contract put all of the burden on the patient and have conditions that require you to take the medication exactly as prescribed regardless of the circumstances. I was discharge by a doctor because I was feeling good enough that I did not feel I need to take my pain medication, but after my mandatory urine test showed I did not have Oxycontin in my system the doctor said that because the prescription says to take the medication everyday even if I don't feel that I need them at that time the assumption by the doctors and any law enforcement entity that might be reviewing that practices patient record is that you are not taking your medication because you have sold them or have taken more than prescribed and are out of them. I was kicked out of the practice and now have a major red flag on my record that prevented me from finding a new doctor willing to prescribe my medication. This incident and others have caused me to have to go "cold turkey" off of these painkillers. The withdraw consist of nausea, vomiting, loss of apatite, dehydration, insomnia, nightmares when you do sleep, which is usually only because your body and mind are so sleep deprived that you just crash. You will suffer from cold-sweats, swinging between hot and cold flashes, violent and uncontrollable nervous and muscular spasms. Then factor in that I have chronic pain daily, so without the medication you end up suffering from what is call hyper-analgesia. This means that as a result of taking these medications for a long period of time that you actually will become hyper-sensitive to your pain. The whole ordeal lasts for a week or more and if you already have sever health problems the withdraw will make it so that you wish you would just die. The risk of death is actually very real for the anti-depressant/ anti-anxiety medications known as benzodiazipines if they go cold turkey off of them. The withdraw is terrible as well and can result in death. Most responsible doctors that are writing these medications, but take a patient off of them out of fear that they might be abusing or selling there prescription will write another medication to prevent these potentially deadly results, but not all are so understanding. Now people that abuse these medications and end up suffering withdraw don't get much sympathy from me, but with the laws being as they are and the presumption that you are guilty of abuse despite absence of real evidence forces doctor to deny real patient the medications they require. These are just a few of the major problems with the current measures used in KY to stop prescription abuse. I am posting my original letter to the editor here to let you see what I told the paper, but also to raise awareness of the very real problem of honest patients that are made to suffer at the hands of the abusers and the laws that are aimed at stopping them. Real patients suffering from illnesses requiring these medications and good, honest doctors are made to suffer by the over-reaching, one-size-fits-all laws. I hope you will read it and consider that someday you or someone you love will have to take these medications, but are forced to fight against a system that wants to make it as hard as possible for doctors and patients to use such medications because some people are abusing them. We must allow doctors to treat each patient individually on a case by case basis. Legislators and law enforcement have not business telling good doctors what is appropriate treatment of patients. WE don't have to allow people with not medical training to be the ones that determine how a patient should be treated. Doctors already have boards of other doctors that review the treatments of doctors under their watch. This system of peer review of individual doctors and patients is far safer for patients than letting the DEA or Attorney General to review these cases and make health care decisions, which was a provision bill supporters sought, but fortunately had to remove from the bills. Here is my letter and I appreciate you taking the time to read this lengthy post, but it is a subject that directly affects me and probably someone you know. With the "Baby Boom" generation are now elderly and half of them suffer from some chronic illness and a large percentage of those patients have to cope with some level of chronic pain. Should your grandma have to suffer because lawmakers are over-reaching in order from preventing people that choose to abuse prescription pills. Here is the original letter:

"I was encouraged to see a doctor make the point that while we should try to combat the serious problem Kentucky has with prescription pill abuse, we must not compromise the ability of doctors and patients that suffer from legitimate, physical pain. Chronic pain is debilitating and can destroy a persons life. People are suffering to the point that they can not work, socialize, exercise, and in some cases just eating causes unbearable pain. We must not over reach in the effort to curb diversion of prescription pills, primarily pain medication. Kentucky and most Appalachian states, unfortunately are plagued with pill abuse. However, in the effort to combat this problem many patients that rely on their legal pain medication just to function are finding it increasingly difficult to find doctors willing to prescribe these medications because of fear that a patient might lie or deceive them and wile acting in good faith the patient ends up caught selling their prescriptions. The way the laws are now the doctor can be prosecuted and lose their license for the actions of the patient that lied to them. Kentucky doctors are turning away patients that they know have a real cause of pain and need relief because of the chance that one might trick them. I acknowledge that there have been quack doctors that are glorified dope dealers, but since the implication of some good legislation, like KASPAR, have mostly been rooted out. This resulted in abusers going to the infamous "pill mills" in Florida, that have just recently been dealt with. An addict will always find a way to get their fix to avoid the nightmarish experience of opiate withdraw. For these people they stopped getting "high" a long time ago. They continue to use despite a true desire to get clean because the withdraw is so horrible. They need treatment not jail if they ever hope to live a productive, happy life. But, in the effort to deal with abuse many real pain sufferers have had to go through the ravages of withdraw on top of their very real pain because they can not get the proper treatment legally because the laws make getting the help they need unnecessarily difficult.

While I think KASPAR is a start, it needs some major improvements. It does allow doctors to see if a patient has gotten meds from another doctor. We don't want people to doctor shop, but because so many doctors are refusing to write these prescriptions regardless of the patient there are now patients that in fact have to seek out a doctor that will. So, in effect they are forced to doctor shop, but not for the wrong reasons. KASPAR tells a doctor and law enforcement who you are, what medication you receive, the dosing instructions, when, and who wrote the prescription, but it does not give any context as to why a patient might have changes in dosing or changes in doctors. In my case I suffer from pain every single day due to chronic pancreatitis, one of the most painful and difficult to treat diseases one can have. I know people that have had cancer and had at least one acute attack or pancreatitis and they say the pancreatitis was worse than anything the cancer caused. When I have an attack my pain level can more than double, requiring me to ask for an increase in my dose during those attacks. Because the law does not provide that information it appears that I am drug seeking for illicit reasons. Patients pain levels can fluctuate, but KASPAR does not reflect that. It also doesn't inform users in the event patient that receives medication from a regular, primary doctor, but has to be hospitalized because of their illness and they are sent home with a short term increase in dosage by the doctor on duty at the time the patient is discharged. I have been hospitalized well over 100 times in the last 12 years and I have run into this problem first hand. KASPAR only shows that I received a prescription from the hospital or ER doctor, but not why a different doctor has changed my dose temporarily.

Another issue that is not reflected in KASPAR is the possibility that your doctor that writes your medication retires or moves away. You are then required to find a new doctor to take over, but by doing so it can appear as if a patient is doctor shopping just to score drugs, when that is not the case. Now most doctors use contracts with patients that receive narcotic medications that state that the patient will only receive those medications from one doctor and can not receive any other prescriptions including from emergency room or hospital doctors. The contract also can stipulate that a patient must submit to urine and / or blood tests to ensure they are not taking any illegal drugs and to ensure that they have the medication they are prescribed in their system. If a patient does not have the proper medication in their system the assumption is that they sold it or took more than prescribed and have run out. Doctors have to be so strict that even if you are feeling better and choose not to take your pain medication, but the prescription instructs that the medication be taken daily, you can be discharged for violating your contract. So, basically you get kicked out of that practice and have a red flag on your KASPAR report for NOT taking medication if you are not in pain for any period of time. These test are intrusive and invade our privacy. They can be especially problematic for many cancer and other patients like myself that have a surgical implant that provides IV access because of the countless IVs and blood tests. The accumulation of over a decade of having doctors and nurses stick me with needles has destroyed most of my veins and they can no longer be accessed so the doctor has to have the specific equipment and a specifically trained nurse to access my medi-port. So if they do not have those required things then they have to attempt to draw blood from damaged veins that sometime will not draw blood. I am often subjected to suffer through as many as five or more attempts to access a viable vein. This is painful, intrusive, and would not be necessarily if the doctors were allowed to practice patient specific testing and treatment. Instead they have to ad hear to one-size-fits-all dosing, intrusive testing. This is impractical and in a sense cruel, but the fear of the mere chance a patient might be getting more than they need or are selling those prescriptions prevents real patients from getting the care that doctors would normally provide if they were not constrained by laws made by legislators, instead of medical professionals.

As for dealing with those that are addicted the answer is not jail time. Prisoners have access to any drug they want, no matter how hard the prisons try to prevent drugs being smuggled in. The first step to addressing an addict arrested with a personal supply is to sentence them to legally mandated rehab. It is far cheaper to pay for 90 days of rehab and the chance for an person to free themselves from the bondage of addiction and be able to go on to lead a sober and full life than it is to lock them up for several years where they receive little to no treatment and have access to prison yard fixes. They often get out worse of than they were before incarceration. Keep in mind this is for people that demonstrate that they are addicts and if they do sell it is only to pay for the addiction. Those that prey on these people and sell large amounts of narcotics are a menace and deserve punishment. We have to approach the problem of addiction with proper education, prevention and treatment of addiction as opposed to just throwing non-violent people that are suffering from a disease in prison with murders and rapist. I was glad to hear that the Governor is increase areas of the state budget aimed at prevention and treatment as opposed to packing over populated prisons at the tax payers expense. We have to focus on prescription abuse, but we do not have to have legitimate chronic pain suffers and good doctors persecuted and prevented from giving and receiving proper medical treatment in the name of preventing a minority of people from abusing these medications that are vital to the functioning and well-being of others."

Thank you for your time and if you are concerned about this issue write your own letters to the editor and especially your representative in Frankfort. Take care.

No comments:

Post a Comment