Prescribing Narcs with Training Wheels


You, doctor, are an idiot.  First, you don’t treat pain we’ll enough and need to give more narcotics (circa 2000). Now, you treat pain too much and people are getting addicted to the medication (now).  This is the mentality of the government, insurance companies, and even the AMA/AAFP.   It just has to be the doctors’ fault. Other then the pill mills, has there really been proof that doctors are that atrocious in giving pain medication?  I am not talking about an isolated case but an actually study?  Well, I would doubt it but when does evidence matter when you can make doctors scapegoats. This just in:

  • The Food and Drug Administration is reconsidering whether doctors who prescribe painkillers like OxyContin should be required to take safety training courses, according to federal documents.
  • The review comes as regulators disclosed that the number of doctors who completed voluntary training programs is less than half that targeted by the agency.

How patronizing is this?  We are treated like morons who need “safety” courses.  And they wonder why anyone wants to volunteer to spend their precious time doing this BS?

Oh, and as a side note, I know of hardly any doctor who WANTS to prescribe narcotics.  It is a royal pain in the ass.  And now you want to make it harder?  Or take that responsibility away from?  Ow, twist my arm.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  9 comments for “Prescribing Narcs with Training Wheels

  1. Karen Marie Yone
    May 5, 2016 at 2:14 pm

    It is terrible for government to interfere in Doctor/patient relationship and care. Doctors are perfectly qualified to dispense pain medication and monitor its use by patient. You are potentially depriving deserving patients of relief from pain

    May 4, 2016 at 5:44 pm

    Prescription drugs are painted as a significant problem for patients, physicians, and arguably for the country as a whole. Prescribing physicians need to know that at this time, law enforcement has the upper hand and compliance with any and all regulations, known and unknown, is mandatory. Any deviation will cost you dearly.
    It shouldn’t be like this…but the system is rigged and it’s not in our favor. Every doctor must be very, very careful.

  3. Pat
    May 4, 2016 at 1:41 pm

    I thought “safety training courses” were part of med school and residency – which of course, they are. Anyone who has completed a credible residency knows exactly what perils and pitfalls accompany long-term opioid treatment, for bot patient and physician. No safety course imaginable by government drones will stop the problems caused by docs who are sleazy, lazy, or just burned out; no stupid safety course will stop whiny and/or addicted patients from continually hunting narcotics.

    This is TSA logic all over again, where new regulation masquerades as serious prevention.

  4. Beth
    May 4, 2016 at 1:25 pm

    The real criminals here are the Sackler brothers(Arthur, Mortimer & Raymond) and Perdue Pharma and the pill mills. Their story is in the book, DREAMLAND, by Sam Quinones. Intentional Ignorance. Yet the Sackler brothers are praised for being billionaires. El Chapo? Not so much.

  5. Sir Allyagottadois
    May 4, 2016 at 10:18 am

    One of the most common causes of death in the US is heart disease .We probably need a certification for licensure that we can treat this. The problem is not doctors who want to treat pain with compassion, but the industry claiming we don’t ( that’s when our happy faces started ) and megaprofit pharmaceuticals who push the drugs. They are the dope pushers in the country. We are the patsies. The patsies of compassion who actually care about the other human being.

  6. Steve O'
    May 4, 2016 at 9:11 am

    Never fear, it’s part of the New Boodle shakedown. Look at the wonders which the Federal Department of Transportation shook out of the trees.

    The National Registry of Certified Medical Examiners is a spontaneous medical board created by the Department of Transportation to certify individuals in fitness to do federal DOT drivers’ examinations. These are the requirements for obtaining an interstate CDL – commercial driver’s license.
    “All commercial drivers whose current medical certificate expires on or after May 21, 2014, at expiration of that certificate must be examined by a medical professional listed on the National Registry of Certified Medical Examiners.” I am not qualified by the DOT to do this examination.
    Qualification means spending a bundle on a course, and then another bundle on a certificate. Who’s going to pay for this outlay? You guessed it. The drivers.
    Most second-year medical students can expertly do the examination needed for the CDL. I took a look at the “doctors” who have been certified by the DOT. I searched within a hundred mile radius of my practice. There are 21 certified examiners, A majority are not doing new examinations. They are employees of trucking-oriented organizations, an in-house examiner seeing only internal candidates. {There’s some objectivity for you! How many in-house drivers do you think they fail?} Over half as physician assistants, with no certified physician available. Several are chiropractors, several are nurse practitioners, a smattering of them are DO’s and MD’s. My state looks to have about 20 examiners who can be directly approached for an examination, and I sure don’t live in Rhode Island.
    How much is the exam? I don’t know. How much is the cost of obtaining certification? I don’t know.

    I’ll bet they’re both a pile of dough, which is sucked out of the drivers to the Feds. It hammers independent drivers, at the sake of the corporate truckers.

    What if your license is going to run out before you get your appointment? Would a little bit of cash under the table for an “accelerated visit” help? Who knows?

    I think this would be a dandy plan for the Feds – HHS, CMS, all the alphabets – in creating a National Registry of Certified Medical Examiners under the DOJ to prescribe narcotics. Running the re-qualification courses annually for the Certifieds, and relicensing them could run into some serious dough – a couple of grand per provider. There’s no need to cut out the intermediate providers such as the chiropractors and such – if they can examine truckers, they can prescribe pain meds, I figure.

    Of course, where’s a Certified Pain Manager going to get the dollar-stream that’s needed to pay for annual certification?

    You guessed it.

    • JRDO
      May 4, 2016 at 10:01 am

      I recently had a patient come to see me with a form from the CDL certified doctor. There was an isolated PAC on the EKG and the CDL doctor sent the patient to me with a form for me (the patient’s PCP) to sign off on to say that the patient was okay. WTF? I am not qualified to do the exam but I am qualified to supervise the doctor who does?

      It’s just another example of how PCP offices become the ultimate liability dumping ground- “check with your doctor before having sex”, “check with your doctor before beginning an exercise program”, “have your doctor sign this form that you can do the physical for the police academy”, “have your doctor sign this camp form” etc.

    • Sir Lance-a-lot
      May 4, 2016 at 12:21 pm

      I’m an official, genuine, certified DOT-exam-doer.

      The on-line “course” was something like $350, with another charge for the test and certification (my employer, a for-profit urgent care, paid).

      I had to memorize a wide selection of random administrative facts that Uncle Sam wanted me to know, and which could be easily looked up, truck on down to the local Prometric testing center, say hello to the nice people who watched do my ABFM board cert., empty my pockets, get metal-scanned, and sit down and regurgitate it all for a few hours.
      Oh, and as it turned out, I was supposed to bring MY ACTUAL MEDICAL LICENSE along with me to the test – I was already fully registered and confirmed – WTF? – fortunately, my office manager was able to fax them a copy of her copy, after they figured out how to use the fax machine…
      Completely pointless.

      Our place charges something like $75 to do the test (they have deals with local trucking companies as well, and I ASSume that they cut them a discount). Considering the amount of staff time required from start to finish, I presume it is a loss-leader, designed to get people in the door, so that they’ll come back later. What the business guys in charge don’t realize, though, is that DOT certification is a scam, if not for the doctors, then certainly for the patients – they will go out of their way to get their DOT exam at a place that’s never seen them before, and will never see them again, because they’re lying about their medical histories and have just taken a handful of their aunt’s diabetes pills and their buddy’s HTN pills so they could pass.

      I see anywhere from zero to five or six DOT exams a day, mixed in with the head colds, chest colds, URIs, sinus infections, grippes, post nasal drips, influenzas, and bronchitides. I have had only one guy so far where I had to contact his pcp – according to the rules, he needed evidence of a stress test within the past 2 years because he’d had an angioplasty. If he hadn’t told me, though, I would never have known, and would have just passed him.

      And, yes, a second year medical student could do the exam – the exam itself takes me about five minutes, including “bullshiting time,” which is less time than it takes me to fill out the forms.

  7. Thomas Guastavino
    May 4, 2016 at 6:22 am

    This has finally put me over the edge. I call on each and every one of our societies to send a letter to the government and media outlets placing the blame for this squarely where it lies. If they do not I intend to drop out of membership.

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