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parallax 
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Re: “UVM Medical Center Doctors Curb Opiate Prescriptions

Mr. Grape adds a very important dimension to this. Chronic pain management from afflictions like RA can only be managed so far with Ibuprofen or gabapentin. The crippling afflictions he mentions are not trivial and it is completely unclear why there seems to be a tendency to couple chronic or acute pain management methods with either the concerns of criminal conduct or to imagined moral failings. If doctors are susceptible to black market temptations, supplies susceptible to theft, pharmaceutical companies susceptible to the lucrative promotion of addictive product and the federal government tolerant of such abuses in the name of "small government" it is unclear why there should be a burden placed on patients such as Mr. Grape to suffer the experience of chronic pain in this age of modern medicine.

14 likes, 2 dislikes
Posted by parallax on 10/11/2018 at 4:14 PM

Re: “UVM Medical Center Doctors Curb Opiate Prescriptions

Missing from this article are the actual guidelines, maximum daily doses, etc. that are mention in the article - or even a link. I would love to see how the management of pain is being addressed and how it is coordinated with lower doses of opiates, since the unrivaled power of opiates is in their pain management properties. What is being done instead? What is being used and are there concerns about abuse or addiction with those medications as well?

20 likes, 3 dislikes
Posted by parallax on 10/11/2018 at 2:46 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

i understand your concerns @David Skillman, however I think the same limitations in people that move them towards addiction also prevent them from being able to "take responsibility for their actions and bad choices". most people i've met who've made really bad life decisions didn't know at the time how bad those choices were. those who were able to take responsibility in terms of remorse or reparations had to have some kind of intervention, whether medical, psychological or reaching some kind of desperate situation where circumstances force them into a learning curve. but not everyone suffers. i've met 'functional' alcoholics and opiate users who don't bottom-out, don't commit robberies, earn a decent wage and live a productive life - as addicts, but not criminals in the sense of having to take responsibility for anything at all. addiction isn't by definition about depravity and desperation although it often is.

1 like, 0 dislikes
Posted by parallax on 04/27/2017 at 2:48 PM

Re: “Do No Harm: New Rules Discourage Overprescribing Opiates

The worst part seems to be the idea that we have to trade painfree medical treatment for stringent controls. This isn't a zero-sum game and it's possible to obtain both as long as you're willing to accept the consequences. Pain perception is impossible to understand objectively so pain meds can't be presumed necessary or excessive. If the patient says they're in pain then presume they're in pain and experience should guide the proper prescribing, not the state. The idea that you can "go into a doctor's office and come out with a bagful." isn't about pain, it's about criminal activity on the part of the doctor, not the patient. The consumption or illegal resale of the pills is about very difficult socio-economic problems, not about surgical procedure aftermath or chronic pain and it's the price we pay for addictive pain meds. We made this tradeoff easily enough when adopted the automobile as a lifestyle improvement device and we quietly accept half a million deaths each year. We accept this easily with readily available nicotine and pay the price of cancer deaths and medical support for the adult addicts. It's so easy with cigarettes and cars and alcohol and a whole host of things. Painfree medical treatment is an incredibly awesome achievement and we're worried about a few deaths each year? We're complaining about decreased productivity and costs to society by supporting the medically needy addicts? Big deal. That's pennies compared to what we're already paying for due to cars, nicotine and alcohol. How about considering the question of *over* prescription and consumption outside of the context of the doctor-patient relationship and focus on standards of care instead of treating pain intolerance or even opium addiction as some kind of moral failing that doesn't deserve relief.

4 likes, 0 dislikes
Posted by parallax on 04/27/2017 at 11:38 AM

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