The Incredible Shrinking Physician by Pat Conrad MD
Fellow physicians, do you feel yourselves shrinking? You should. After slogging through post-graduate training and years of private practice, you may have learned some ways to evaluate and treat patients that do not fit neatly into pre-formed, arbitrary whims handed down from the medical experts prowling state capitals, D.C., and lawyers’ offices. And most of us have learned that in the Age of Homogenizing Quality, experience and intuition count for increasingly less if anything at all.
CVS pharmacies are leading what is bound to be a tsunami of “yes, me too!” that will sweep throughout health care. After being told to prescribe more opioids for years, then told not to for years, and then told physicians are THE problem, CVS is going to further protect us (and everyone else) from ourselves by limiting opioids to seven day prescriptions “for certain conditions.” I didn’t see in the article exactly what conditions they will specify, but how nice of a store chain to empower pharmacists to tell me, burdened with an undue amount of clinical experience, what a given condition would merit for pain control. “Daily dosage limits will be based on the strength of the painkiller and CVS pharmacists will require the use of immediate-release formulations of opioids before extended-release opioids are dispensed.” Because I can’t be trusted to write for ten Oxycontins as opposed to fifteen Percocets.
“When filling prescription for opioid pills, pharmacists will also be required to talk to patients about the risks of addiction, secure storage of medications in the home and proper disposal.” Bet the poor pharmacists and techs will love that, in between dealing with forgetful seniors bitching about their subsidized drug prices.
“Dr. Troyen Brennan, chief medical officer for CVS Health. ‘We’ve got an epidemic on our hands, and we’ve got clear evidence that, if we restrict access to these medications, more than we’re doing so right now, we’ll reduce the amount of addiction that occurs, and as a result of that, we’ll reduce the amount of human suffering.'” A mouthpiece like this would make a fine addition to any major insurance, hospital corporation, or short list for surgeon general nominees.
This story is more evidence that the medical profession is shrinking as rapidly as the judgment and experience of its highly trained practitioners is being discarded.
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So Cvs has decided to make more heroin addicts. We all know that the way people get hooked on heroin is that when someone can’t afford lortabs the go to heroin. So if cvs goes forward with this aren’t they contributing to heroin addiction. We should be distributing lortabs for free without a presciption to keep people from turning to heroin.
Concerning the “Opioid Epidemic”
So in 2015, 35,092 people died in car wrecks. A “high” or peak of motor vehicles deaths was 54,589 people died on the nation’s roads in 1972.
So, in 2015 13,000 died of heroin overdoses. Last I looked, I couldn’t prescribe smack. (heroin to the babes in the woods out there)
In 2015 the top graph on this page: https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates shows that the deaths from all opioids was under 35,000 roughly if I got that close to correct. O.K., 20,000 were sick with life and killed themselves with non-heroin opioids. That is too bad.
Obviously, this conclusively shows we should outlaw motor vehicles/cars and all of us should ride bicycles or walk cause cars cause as many deaths as narcotics!!
Sheesh, the only epidemic is in the minds of the media and the ivory tower authorities.
Seeing people get sent home with legitimate, documented painful conditions that would benefit from a short course of narcotic analgesia is making me sick. (Ever try passing a kidney stone on tramadol?)
Now obviously in the areas where people have a high incidence of heroin addiction there needs to be consideration of some sort of treatment programs. Money or lack thereof is the deal here as is the uninsured and low socioeconomic status of the sufferers.
If there is an “epidemic” of heroin addicts walking then all people walking around should have narcan in their back pockets to be “ready to treat”.
The State of Washington Health Care Authority sent a letter out last month to protect our patients from unscrupulous prescribers . Starting Nov 1 any new start narcotic scripts cannot be written for more than 42 doses. Unless of course the prescriber writes ‘exempt’ on the script. Here is the policy for those suffering from insomnia: https://www.hca.wa.gov/assets/billers-and-providers/opioid-policy.pdf
I love the reference to “objective pain scale”. How nice it would be to have one!
there is the upside that when your patients complain, you can now blame it not only on their insurance company but also on cvs…they have more people to call and perhaps they’ll leave you alone a little more?….