Hydrocodone combos now a schedule II

[greenmood]

We bluntly tell our patients that we will not take away their pain, and that our goal is that they are capable of getting up out of bed and moving around while coping with their pain. Note I said capable, not comfortable.

 

And these are patients who've just had major abdominal surgery, some of whom were in chronic pain prior.

 

I think collaborative goal-setting is vital. I've had several patients stop asking for pain meds after I simply explain the limitations of modern medicine to make them awake, alert, and pain free after someone cuts them open and rummages around inside.

 

 

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[rachiehayes]

I agree with greenmood.

I am 24 and have arthritis. Not to spill my life story, but DMARDs changed my life. I would be disabled without. Yes I still live with daily chronic pain that NSAIDs don't completely cover, but it reminds me I'm human.

 

My point is, patients should be aware of what the goal is. Is it to return 100% normal/pain free? Or learning how to adjust to a "new" normal?

[ventana]

very first discussion I used to have with chronic pain patients was that

 

1) life is going to involve pain - we can not change that

2) a good day is when pain is 2-3/10 - enjoy those days because the bad days when pain is 7-9/10 are coming

3) we can not make you pain free

4) you need to come to grips with the above

 

 

Amazing how many of them never had been told this by a provider.......

[True Anomaly]

For further edification, I submit this article that references a Wall Street Journal article from a couple years ago, which discusses one of the doctors at the very center of the push to aggressively treat chronic pain with opioids, as well as not knowing (or just overlooking) the dangers of these medications- and also his associations with pharm companies who make said drugs:

 

http://www.thepoisonreview.com/2012/12/16/the-money-and-influence-behind-pain-as-a-fifth-vital-sign/

 

I do have the original WSJ article if anyone is interested.

 

We, as a profession (medical I mean- not just PA), seem to be struggling to identify those patients who will most likely become dependent or addicted to these medications, or at least not be functional while taking them.  I submit my own anecdotal experience that some personality disorders, particularly borderline and histrionic, can predispose someone to developing dependence- which I don't think will shock anyone here- but many times we see these patients who aren't formally diagnosed with any such disorder- they just display these characteristics.  I also believe some patients who display an inability to solve problems laid out in front of them or an inability to overcome obstacles are far less likely to understand how to cope with pain or understand the dangers of these medications.  Obviously the ER sees a disproportionate number of these types of patients because they are more likely not to work, not have insurance, not have jobs or have access to a PCP- or understand what a PCP is for.  They present with a pain complaint in the ED, and in the day and age of "moving the meat" and pain satisfaction scores, these patients are more likely to get opioids as first-line treatment- then the cycle starts.  If I have a patient like this who does not have a history of opioid use, I try to counsel  - sometimes I am successful, and sometimes I'm not.  I think the medical establishment owes it to these patients to be much more cautious with using opioids for pain complaints- particularly conditions more likely to develop into chronic problems like low back pain or chronic dental pain.  Again, just my own anecdotal experience talking here- your mileage may vary.

[EMEDPA]

a friend of mine just did a year sabbatical in Australia. his first day there he wrote more vicodin than all the other docs did in a year. the docs explained the culture to him and he went to writing it once/mo like they did.

[True Anomaly]

a friend of mine just did a year sabbatical in Australia. his first day there he wrote more vicodin than all the other docs did in a year. the docs explained the culture to him and he went to writing it once/mo like they did.

 

I can kind of assume what the culture is like from your post, but would you elaborate a bit?

[EMEDPA]

I can kind of assume what the culture is like from your post, but would you elaborate a bit?

no narcs unless major fx or burn. OTC T3 and nsaids for minor fxs, back pain, sprains/strains, etc.

The concept of "chronic pain" is very different there. here chronic pain = narcs, pain clinics, etc. There it = P.T., tylenol, nsaids, and suck it up and deal with it. American's are wimps compared to the rest of the world when it comes to pain. I'm sure you have seen hang nails, sunburn, super minor strains, abrasions, bug bites, etc like I have here demanding percocet, etc

[Guest Paula]

a friend of mine just did a year sabbatical in Australia. his first day there he wrote more vicodin than all the other docs did in a year. the docs explained the culture to him and he went to writing it once/mo like they did.

 

He achieved the "Candy Man for a Day" reward.

[kkvanlan]

E prescribing of controlled substance (even C-2's) is legal but most practitioners do not have the required software with added security to do it. Why is this? I'm guessing it's expensive and individual states may have added restictions. This has been legal a long time and it drives me crazy that more prescribers do not utilize it.  I'm betting once hydrocodone combos are C-2 many more prescribers will be looking into this.

 

FYI -  I'm a pharmacist applying to PA school.

 

On March 31, 2010, DEA's Interim Final Rule with Request for Comment titled "Electronic Prescriptions for Controlled Substances" [Docket No. DEA-218, RIN 1117-AA61] was published in the Federal Register. The rule became effective June 1, 2010.

The rule revises DEA regulations to provide practitioners with the option of writing prescriptions for controlled substances electronically. The regulations also permit pharmacies to receive, dispense, and archive these electronic prescriptions. These regulations are an addition to, not a replacement of, the existing rules. The regulations provide pharmacies, hospitals, and practitioners with the ability to use modern technology for controlled substance prescriptions while maintaining the closed system of controls on controlled substances.