Getting Your Fix by Pat Conrad MD


Pain control was never an appropriate area for federal oversight. For all it’s good in easing suffering at the local level, medicine has grown insufferably tiresome as a vehicle for busybodies to crawl up each other’s rear while trying to increase their own importance. Yeah, I just described the AMA, AAFP, et al, who substitute posturing and nosiness for actual achievement. These frauds have been joined by the American College of Physicians, American Psychiatric Association, and American Society of Addiction Medicine in celebrating congressional passage of the Comprehensive Addiction and Recovery Act (CARA) now slithering its way to the president’s desk. The bill is supposed to increase access to naloxone and buprenorphine, fund more addiction services; dump more tax dollars on states for recovery, education and treatment programs, and drug monitoring programs.

Nitin Damale, MD, president of ACP, said, “We urge the President to immediately sign this important bipartisan legislation that helps alleviate the suffering of the thousands of individuals who suffer from these addictions.”

President of AAFP Wanda Filer, MD: “[CARA] will expand much-needed access to care for Americans struggling with substance abuse disorders — a policy long-supported by the [AAFP] and our members”, like any other do-gooder federal program using other people’s money to boss around doctors and patients. R. Jeffrey Goldsmith, MD, ASAM prez is “thrilled…With adequate funding, we believe this bill will help save lives.”

Do you think all of this is a good idea? Then how about “funding for the National All Scheduled Prescription Electronic Reporting Act (NASPER)”? Or the “development of a federal task for that will identify best practices for pain management and prescribing medication for pain”? Or the “expansion of the VA Opioid Safety Initiative [requiring] training for safe opioid prescribing and pain management”?

“But we cannot stop here”, says Saul Levin, MD, CEO of APA, “These programs must be fully funded to be effective. APA looks forward to continuing to work with Congress to curb this epidemic.”

Chair of the AMA Board of Trustees Patrice Harris, MD thinks, “This legislation represents an important step in addressing the public health epidemic of opioid misuse, but it will not be fully realized without new resources to support these programs and policies.” Ah yes, new resources. Remember what I’ve said about accepting Caesar’s coin? The legions always follow.

This newest miracle legislation is from the same compassion-industrial complex that made pain a vital sign, pushed hospitals and docs into overprescribing, and then started fining and jailing them for doing so. Yes, there are plenty of shmucks that took advantage of the climate for a sleazy buck, harmed patients in the process, and were deservedly hammered. But the majority of decent physicians have had to spend more time and energy looking over their shoulder at the G-man in the dark trench coat reading the database in the local pharmacy, spending extra money on mandated e-prescribing and Medicaid-compliant script paper, often prescribing less pain meds than they judged necessary. No, I don’t deny that there is an opioid problem, but it won’t be fixed by even more laws that make me want to work in a micro-brew (and the War on Drugs has been such a success…). I have always tended to be very tight-fisted with the opioids, but that doesn’t mean I trust the medical judgment of an ignorant bureaucrat or blowhard congressman as much as a trained physician. Doctors should be immediately suspicious of anything, ANYTHING agreed to by the AMA, ACP, and AAFP. Doctors should not be grateful to this government for “resources” – they should hate and fear it. This legislation, NASPER, and subsequent steps to fix the problems they will cause will only do for medicine what the TSA has done for flying.

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 “Getting Your Fix by Pat Conrad MD

  1. Pain warrior
    July 21, 2016 at 10:18 pm

    The war on drugs is just a war on people.
    Vulnerable people.

  2. dickie hiii
    July 21, 2016 at 5:46 pm

    telling docs to treat pain and then prosecute them for doing so was a preplanned attack on private doctors. everyone knows the large HMOs ie Kaiser refill opiates for pts for years without exams as had the VA, county clinics, etc yet Kaiser and other large pseudogovt programs have never been even investigated for this severe breach of quality pt care

  3. Dawn Anewday
    July 21, 2016 at 1:28 pm

    Just tell me what chronic pain patients and poly trauma patients are supposed to do now. Naproxen and Ibuprofen are going to destroy their circulatory system and kidneys and eat holes in their stomachs. Aspirin will destroy their stomachs and cause strokes. I’ve been asked to testify against fire department budgets for rescuing horribly injured people. The aftermath of constant pain and disability isn’t worth it. No one wants to pay to care for these people. Do gooders want them off pain medication and confined to bed the rest of their lives. They have been abandoned by society because of their disabilities and now they are being abandoned again in their pain. May all you drug Nazis succumb to the same. Patients and even their care givers are committing suicide now. Anybody got the stats?

    • Ann Sutton
      July 22, 2016 at 3:51 pm

      First I’ve been wondering about the stats too. I’ve heard/read that suicides have increased in pain patients with more contemplating it. I was reading a blog of chronic pain patients and they were either going to try herion or commit suicide if they can’t get relief. Of course both of those are horrible choices but I can understand completely.
      I am under the care of a pain management Doctor that told me on my last visit a few weeks ago he’d rather not prescribe ANY pain meds. He said one doctor had just been sentenced to 30 years and another 17 years in prison. In fact that day they arrested a doctor in another city not far from my doctor. I suspect but don’t know for sure the two he was talking about were arrested before the guidelines came out since it had only been a couple of months since they ” went into effect”.
      I have 12 herniated discs, 5 fused discs, arachnoditis , cervical, thoracic and lumbar stenosis and an intrathecal infusion pain pump. The pump is another story in itself but let us say for right now it isn’t helping much. I was on 3 Percocet a day but was cut back to two a day. My original Doctor ( he moved) wanted me on a 24 hour oxycodone patch but insurance wouldn’t pay and I couldn’t afford it. Yet two Percocet on a good day helps me take a shower and do a couple of small things. They only cut my Percocet by one a day which may sound not like much but I had a system down to get through the other hours. Also this is where the pump comes in. I had fentaynl and buvicaine in it but I had to take a 10 month holiday since I’d had it for 10 years. The fentaynl combo was working good along with the 3 Percocet . Now the pump has morphine and buvacaine and they are trying to find the right dose. So every month they increase it 15-20%. It’s going to take a lot of morphine to replace fentaynl . So I’m in worst shape then I was in 2003 and can’t do a thing about it.
      I don’t believe some bureaucrats should be dictating to the legit doctors ( not pain pill mills doctors) how to treat their patients. We aren’t paper dolls cut from the same pattern where one treatment is right for everyone. Now the doctors are so scared to write a prescription for fear of having to go to prison. So tell me who does that hurt? The chronic pain patients of course. Heck from my understanding they are cutting back on pain meds post op in the hospitals so the patient won’t become an addict!!! No just let them hurt is the way to go.
      What happened to “do the patient no harm?!?!”
      It’s been ” discovered” supposedly since this all started that some people have genetic factors that make them addicts. Sorry but I don’t buy they just figured that out. They already knew acoholics had different genes making them more prone to be an addict. I would think those people would be at risk to be an drug addict too. Some people just want an escape whether it’s just a few drinks or a bottle every night. People have to be desperate to use meth knowing some of the things it’s made with yet they use it. I personally believe and I might be completely off base but most of the people overdosing aren’t all these “suburbanites”, but chronic users that buy drugs on the street, not knowing the strength or ” ingredients” and don’t care…. They just want their next fix.
      As we all know whether it’s someone that makes six figure income, homeless or unemployed person if they don’t want help with any addiction you can’t do anything. They have to want to come clean to be helped but at the expense of others. There may be a day that I take the “easy” way out because I can’t take the pain any longer but will that get the gov’t out of my doctors office? No!!! I’m sure there are some bad apples in every profession but why make everyone else suffer? The gov’t can build these rehab facilities and everything else but I predict they will close them for lack of use. Your taxpayers money wasted because they don’t know what they’re doing.
      I just know I want some relief but it doesn’t look like I’m going to get any. Another thing that is interesting is the guidelines are VOLUNTARY as long as you follow the rules. My pain management already does everything required but the Doctor is more scared of jail then you hurting.
      Thank you for reading this as it is long but we HAVE to step up for our rights!! No one else will.

  4. Perry
    July 20, 2016 at 9:25 am

    And the pendulum now swings back as we discovered the meddling and intervention of pseudo-medical organizations promoting aggressive pain relief has now created a huge problem. More money will be spent and it will be harder for legitimate patients to get legitimate pain relief.

  5. Sir Hakum of Hugo
    July 20, 2016 at 8:46 am

    Life was much easier when I made sandwiches at Burger King as a youth.
    Working at a Micro-Brewery sounds a lot like the grown up version.

    Happy customers, paid in cash, and no night time calls.

    Perhaps I should fall back on my organic chemistry and become a bartender.

    • DocRon
      July 21, 2016 at 11:14 am

      Yeah, I am sure you will be real pleased with your paycheck at the end of the week.

      • Zoann Murphy
        July 22, 2016 at 1:50 am

        It will be more than the reimbursement you get from Medicare/Medicaid.

      • Sir Hakum of Hugo
        July 22, 2016 at 12:38 pm

        As re-imbursements decrease and costs rise, the break even point is fast approaching.

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