It Never Ends
It’s always about control, ain’t it? You and I were taught to use a bunch of different pills for different complaints and sent out into the world to do just that. Then we were told we weren’t using enough of those pills for people that had too much chronic pain, and that said pain was like any other vital sign, and the minimizing of which could get us fined, censored, or sued. A couple of years later, the same know-it-alls who knew exactly what we should have been doing and told us to, then told us that we had gotten it all wrong, and that the know-it-alls were on to us and we had better shape up and not write so many $^#&# pills for so much pain that wasn’t really that big a deal, or we were going to find ourselves in hot water, likely being fined, delicensed, and/or sued.
And being the trusted and adored class of captive professionals that we are, we were all brought to heal <sic> like good dogs, and then … Virus Panic.
Lot’s of people started doing online health care, and the insurance companies apparently liked that enough to keep sending enough reimbursement (I hate that word) to keep that sector afloat. Ever manipulative, the federal government wants to keep telehealth going for the geographically impaired, and yet last month the Administration moved “to require patients see a doctor in person before getting attention deficit disorder medication or addictive painkillers, toughening access to the drugs against the backdrop of a deepening opioid crisis.” Because cracking down on a beleaguered PriCare doc will really help keep those Chinese Fentanyl deaths down, ahem.
“Patients will need to see a doctor in person at least once to get an initial prescription for drugs that the federal government says have the most potential to be abused — Vicodin, OxyContin, Adderall and Ritalin, for example. Refills could be prescribed over telehealth appointments.
The agency will also clamp down on how doctors can prescribe other, less addictive drugs to patients they’ve never physically met. Substances like codeine, taken to alleviate pain or coughing, Xanax, used to treat anxiety, Ambien, a sleep aid, and buprenorphine, a narcotic used to treat opioid addiction, can be prescribed over telehealth for an initial 30-day dose. Patients would need to see a doctor at least once in person to get a refill.”
As always, I note that the WAR ON DRUGS, Hallelujah! is a joke, has been a dismally lost cause for over forty years, and its only true purpose is to control the law abiding and prune their civil liberties. Society should presume that the physicians they claim to love and trust don’t need to be nagged and monitored to follow the latest treatment fads, and not punish us all for the few bad apples that shall always plague us.
“The new rule seeks to keep expanded access to telehealth that’s important for patients like those in rural areas while also balancing safety, an approach DEA Administrator Anne Milgram referred to as ‘expansion of telemedicine with guardrails.’” So the commissariat is doing it for our own good. That’s nice of them.
“The ease with each Americans have accessed certain medications during the pandemic has helped many get needed treatment, but concerns have also mounted that some companies may take advantage of the lax rules and be overprescribing medications to people who don’t need them, said David Herzberg, a historian of drugs at the University of Buffalo … You don’t want barriers in the way of getting people prescriptions they need. But anytime you remove those barriers it’s also an opportunity for profit seekers to exploit the lax rules and sell the medicines to people who may not need them.”
Who decides who may or may not “need” what? Doubtless, it should be those who aren’t trained and experienced in treating patients that make up the guidelines for those of us who are.
“The proposed rules deliver a major blow to a booming telehealth industry, with tech startups launching in recent years to treat and prescribe medications for mental health or attention deficit disorders.” Wanna bet these were subsidized by Big Pharma?
The DEA “plans to have the new rule in place before the COVID-19 public health emergency expires on May 11 (“the science”), which will effectively end the loosened rules. That could mean people who may seeking treatment from a doctor who is hundreds of miles away need to start developing plans for in-person visits with their doctors now.
And just as they did with opioids, the government encouraged people to engage in a behavior that it is now forcibly restricting. Another turn around the track
Ummmm if I’m not mistaken at least in my state a physician needs to be separately certified to dispense methadone for drug abuse. When I was an FP resident from ’85 to ‘87.5, the program chairman steered me to a couple of moonlighting jobs. One was a Human Service Center where I’d oversee psychotropes of poor mentally ill people. I didn’t know what I was doing but the MSW counselors knew the drugs and I wasn’t an a-hole resident doctor. I enjoyed learning from anyone and they got me up to speed on the drugs. Learned the 2nd Gen anti-psychotics that served me well when I went to a medically under served area after training and had to monitor patients’ drugs who saw a psychiatrist once or twice. The 3rd Gen drugs came out and I had no fear working with those either.
I also moonlighted in a methadone clinic as a resident. When the department chairman mentioned that job I said I have no special license to prescribe methadone for rehab purposes. He told me not to worry as the program was run by the nurses and it had the license to prescribe the methadone. Back then we just called it “meth” but that was long before methamphetamine came on the scene so I have to spell out methadone now.
Opioid rehab is a tough nut to crack. Trying to get poor folks off of it is hard. I saw patients who stayed on miniscule doses of methadone as they feared if they got off it, they’d end up back on heroin (or herion as I saw it spelled of patient filled out forms). They allowed themselves to be subjected to random urine drops as they felt that regimentation helped them to stay clean.
Things are probably completely different now with stuff like buprenorphine. Although, I think using the rehab drugs alone is not that answer for everyone. Psychiatric care (rarely possible), counseling from trained ex-addicts and group therapy is best but I thing the recidivism rate is still pretty high if a person remains in the environment where drugs are available and they remain unemployed.
Oh shoot, years later I saw some addicts on methadone who were going to surgery and they were on like 400 to 600mgs. of methadone daily!!! Freaked me out as back in the day it was rare for anyone to be on 10 to 15 mgs. It appears that the philosophy was “give’em whatever they want”. I think the so-called “rehab” clinic turned them all into methadone addicts which I think is completely wrong!