From a Drs view.....

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Ivy
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As I sit here pondering all the excellent comments to the original blog about my writings, I am drawn to a recent email from a colleague who treats pain. A patient of his had a car accident while on appropriately prescribed opioids that had caused no sedative effects for the past 5 years. Others were injured, and because the driver was on opioids, it is assumed he was driving impaired. The physician may now be implicated, though office exams showed no impairment and the patient signed a "contract" agreeing to not drive impaired. It is possible the physician may be charged with a civil or even a criminal suit. Medical malpractice insurance does not cover expenses nor defense for criminal or civil charges, only for medical malpractice.

The physician writes: "herein lies the real and basic reason doctors are so reluctant to prescribe any medications for patients with painful conditions. If prosecuted and convicted of civil or criminal behavior, you can lose your life savings, your home, and your retirement savings including your 401K and your IRA. You can go to prison, and several well meaning doctors have. Neither your assets nor your freedom are protected."

In fact, another colleague of mine, Jennifer Bolen, JD maintains a website, "The Legal Side of Pain" to help physicians navigate the legal landmines associated with the practice of pain medicine.

The physician further observes: "without a change in the laws regarding civil and criminal liability for doctors who prescribe medications for painful conditions it is unlikely things will change much. Patients in pain will still find it difficult to find a physician willing to treat them. And who can blame physicians for being reluctant to prescribe, given the liability issues that go beyond medical malpractice."

And so, apparently I have added another step to the list of long term solutions necessary for real change in access to appropriate pain management: legislation addressing the liability born by the attending physician of a person with persistent pain being treated with opioids. Don't hold your breath for that one.

Respectfully,
Kathy Hahn ;Pain-Topics.org News/Research UPDATES

Sprinks
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I guess this is one of the

I guess this is one of the many reasons why anesthesiologists have such high mal practice insurance premiums(that and also what goes on in the operating room). Interesting article...I mean it's true I am sure most of us have gotten behind the wheel after taking our meds and haven't given it a second thought(assuming we were drowsy or impaired after taking our meds)...I know I have...I drive all the time after taking my meds as they do not impare my judgment or thinking. The only time I don't drive is at night when I start to get drowsy from the extra ativan or two I take(as prescribed) to help me sleep.

Makes you think twice...you could be totally in the right as far as the accident goes and the other person completely at fault, but you could get in trouble because of one of the MANY stigmas that go with taking opiates.

Ivy
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Yep,Medical malpractice

Yep,Medical malpractice insurance does not cover expenses nor defense for criminal or civil charges,only for medical malpractice.So anesthesiologists would not need to buy more for this purpose..and wow,I did not know that my Dr could be sued for something like this.I don't think it's a good thing,but simply another law put in place as the war on drugs goes on and we become closer to a police state...


On September 25, 2010, the U.S. Drug Enforcement Agency (DEA) will be coordinating a collaborative effort with state and local agencies to remove potentially dangerous controlled substances from the nation’s medicine cabinets. Collection activities will take place from 10:00 am through 2:00 pm at sites throughout the country.

This first-ever National Drug Take-Back Day provides an opportunity for the public to surrender expired, unwanted, or unused controlled substances and other medications for destruction. These drugs are a potential source of supply for theft, diversion, and illegal use and pose a growing risk to public health and safety. This one-day effort is intended to bring a national focus on the issue of increasing controlled-substance abuse.-(I bolded the words)


The program is anonymous and both prescription and over-the-counter solid dosage medications are accepted. However (paraphrased here) the collection of illicit substances such as ___________,_________,_________  is not a part of this initiative.

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Soon it will be illegal to keep expired medications..I'm guessing.

SoloCPhT
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I highly doubt it would

I highly doubt it would become illegal to keep expired medications. Although taking medications for conditions in the future that aren't associated with why you where prescribed the medications is questionable. The DEA made the mistake by not including the aspects of water and surface soil pollution from these medications. There are some areas of the country that have very high levels of antibiotics and hormones in the drinking water supply from the age old practice of flushing unwanted medications. In addition to keeping meds out of kids/teens hands programs like this are also aimed at keeping medications out of both doctors and pharmacist hands when exchanging meds for new scripts. Technially it's illegal for the end user to give there controlled meds to there doctor or pharmacist for "disposal", however it is common practice for doctors/nurses to watch pt's flush there meds and also common for less than legit pharmacists to redispense returned meds for double profit. If there are people that don't want to take there unwanted meds to a collection site I want to atleast urge you not to flush them, there are better ways to get rid of them.

BeavisMom62
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Good point Solo.  Before I

Good point Solo.  Before I knew better, I used to flush our expired samples from the drug closet at work.  Thankfully, I've become enlightened.  It just never occurred to me.  But there are lots of other doctor's offices that still do flush their samples.  I've tried in the past to see if there was somewhere that I could donate expired (which ARE still good) and soon to expire samples, but between all the laws and red tape, its just about impossible.  What a waste of good medicine.

Jesterisin
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opioids

I have been on opiods since 1994 when I had my accident (had someone drop a backhoe on me and took my right foot off) and I don't have the drowsies that I know alot of people have, although I have noticed that my night driving has really gotten worse so I do my best not to drive after dark, I do find myself going to bed alot earlier but I associate that to my age as well. I really hate they have comeup with a new form and understand why but the new form makes me feel terrible and it don't last no where near as long as the orginal and I am told that they have totally quit making the orginal form and I know I don't want to try something new. I am a firm believer in murphy's law, if it works, don't fix it. I wish I knew who I could turn too on this matter. I have called the makers and talked to my pharmist and still have not got any satisifaction. I have an appointment with my Dr. tomorrow and see what he says other than we will have to try this or that, I don't want to try this or that, I want to stay where I am at. Thanks for letting me vent........................................................................................................

Ivy
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SoloCPhT wrote:The DEA made

SoloCPhT wrote:
The DEA made the mistake by not including the aspects of water and surface soil pollution from these medications

I wonder what U.S. Drug Enforcement Agency plan on doing with the collection.I mean,how they plan on disposing of them? That might have made a huge difference to the readers and the outcome.

Ivy
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Speaking of water and surface

Speaking of water and surface soil pollution,this may add to our tons of waste which have been piling up across the nation for more than a generation, but the federal government has yet to decide how to get rid of it permanently.I mean,it's a collection that we have no idea what 'they' are going to do with and I'm certain will cost the Tax payers millions,if not more down the road.

Taxpayers have spent more than $10 billion for exploratory work at a site at Yucca Mountain , Nev.,  including building a deep tunnel.the panel's report isn't due until January 2012. And the group's recommendations aren't binding on the White House or Congress.The country's political leaders are no closer to a safe, permanent disposal plan for nuclear waste than they were a generation ago, when nuclear power became widespread and the Cold War was in full swing.

The nation's accumulated 70,000 tons of extremely radioactive, "high level" waste — uranium and plutonium — has sat in "temporary" storage in 35 states since at least the 1950s.So..it makes you wonder how they will dispose of these medications,or if they have even thought that far.More than likely it will take laws to pass before they can get rid of them all safely.They may or may not be safer in our medicine cabinets-I guess that is yet to be seen.

BeavisMom62
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I wonder what U.S. Drug

I wonder what U.S. Drug Enforcement Agency plan on doing with the collection.I mean,how they plan on disposing of them? That might have made a huge difference to the readers and the outcome. quoting Ivy.

I believe they burn them.  Most biohazardous waste companies that come to doctor offices and hospitals to pick up their needles and gauze and other waste for burning, will also pick up and destroy expired samples.  I can't think of any other way TO destroy them, with the exception of burning. 

elderstatesman
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In answer to the first part

In answer to the first part of the OP's post, I think that going after doctors is simply the logical extension of the "deep pockets" law suite strategy.  The always go after the person with the most money in civil law suits.  I think in the case of doctors, that thinking has just carried over into criminal law.  It now becomes a "blame game" and instead of going after the person or business with the most money, they go after the person with the most importance for prestige issues, but also anyone that can be saddled with shared blame or responsibility.  Of course, it doesn't hurt that expensive possessions and large sums of money can be confiscated from doctors if found guilty.

Sprinks
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EDIT: I wrote: I mean it's

EDIT: I wrote: I mean it's true I am sure most of us have gotten behind the wheel after taking our meds and haven't given it a second thought(assuming we were drowsy or impaired after taking our meds)...I know I have..

I meant to say: in parenthesis; Assuming we were NOT drowsy or impaired after taking our meds). Yikes I would never get behind the wheel if my meds made me sleepy as stated in the rest of my original reply.

My question is..let's say someone(like me) is taking a longer acting opiate(like Opana ER) and someone takes the dose at say 9:00 in the morning. What would happen if they get behind the wheel at say 4:00pm when the medication has just worn off(it all depends on the patient..opana ER is supposed to last 12 hours but many patients say it lasts anywhere from 6 to 8 hours. Anyway what happens if they get pulled over...they would obviously test positive for having the mediation in their system even though it just about stopped working. So...what then they get in trouble because the 12 hour mark isn't up? 9:00am to 4:00pm is seven hours and well below the twelve hour mark. I mean for me at around 4:00-5:00pm I would be ready for my next dose, not to mention the longer acting opiates don't have nearly as many impairing side effects as the immediate acting medications. I don't know the whole thing seems crooked if you ask me. Sometimes an accident is just an accident. What if you were driving on the highway and someone cuts you off and you end up rear ending them(technically it is your fault for hitting them from behind...but THEY cut you off). You would probably end up in BIG trouble..the law would say you tested positive for such and such opiate and the reason why you crashed was because you were driving "impaired" it has nothing to do with the driver cutting you off huh?

As for the removing of the dangerous controlled substances from the medicine cabinets why not just throw them in the garbage? I don't know maybe if you toss them in the trash it could harm the environment, someone let me know the problem(if one exists) for tossing them in the trash? Obviously they shouldn't just be thrown out in the original containers they came in and be in plain sight...but they should be put in discreet containers(away from animals and derelicts that dig through the garbage) and maybe have the top crazy glued shut and wrapped around in duct tape or something that way it makes it VERY VERY difficult to get to. OR take the bottle of meds and fill it water to ruin the medication and throw it out...just an idea or two...