Monday, February 13, 2012

Chronic Pain Management and the DEA

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Rob Streno

Rob Streno

Tue, January 09, 2007

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Stupidity (particularly when it isn’t my own stupidity) makes me angry. Governmental stupidity makes me even angrier. Judicial stupidity has a special ability to raise my ire above a threshold unknown to any individual who has ever ticked me off to any degree whatsoever. So pardon me while I rant about something that is peripherally related to migraines (bear with me and you’ll see the connection).

First of all, I need to tell you that there are a handful of people that are very important to me who suffer from multiple sclerosis. It kind of runs in the extended family, and our part of the country seems to be a hotbed for the disease, so I’ve known more people with MS than the average bear might expect.

This brings me to the story of Richard Paey, from Florida, who suffers both from MS and chronic pain from a spinal cord injury from an automobile accident decades ago. I heard of Mr. Paey’s story through the blogosphere, which led me to a web article posted by Maia Szalavitz, and finally a New York Times article by John Tierney.

The short version of the story is that Richard Paey was in a lot of pain from both MS and his automobile accident. Mr. Paey had obtained relatively large amounts of opioid painkillers using prescriptions. There is some question as to whether or not the prescriptions were valid or forged. According to the NYT article, Mr. Paey claims (along with back up from several of the pharmacists) that all of the prescriptions were given to him by his physician. His physician claims that some of the prescriptions were forged. The article by Maia Szalavitz suggests the doctor was “strong-armed” into that testimony by the Drug Enforcement Agency’s threats of being pulled into the case as an accomplice, but we’ll never know if that’s true.

A couple of apparent ironies about the case are that apparently one of the drugs that was taken into consideration for his trial and sentencing was off-the-shelf acetaminophen. The second irony is that now that he’s serving 25 years in federal prison for drug trafficking, the prison system has given him a morphine pump, which gives him a higher daily dose of stronger medication than he was getting in the first place.

I did some additional research because of this article. What I found was the DEA seems to employ a “take no prisoners” approach when they go about prosecuting drug traffickers. Normally, this would be a good thing, but there seems to be a grey area between the amounts of medication needed for chronic pain management and true drug trafficking, and from some of the accounts that I’ve read, the tactics being used don’t give much of an option for the physicians involved to fight the charges.

The worst part of it? Physicians who used to be willing to write scrips for pain management might not be as willing anymore, fearing retribution or storm trooper tactics from the DEA. Meaning a patient who used to have a legal venue for the pain meds now has to either suffer or look for an illicit source for their relief.

Anonymous
VV
1/11/07 2:30pm
I can't take opiods but I suffer terrible from migraines. Sometimes they stay with me for weeks on end. If I could take the meds I would hope they could be prescribed for me. Heck, I wished there was something that could be prescibed for me now. ;-( The DEA needs to go after the real drug trafficers and leave the people in pain alone.
Anonymous
Ann
1/11/07 2:49pm
I have proof that doctors fear the DEA! My primary care physician told me he could not give me more pain meds for fear of being investigated!!
Anonymous
Country Pain
1/11/07 5:55pm
I have CPS, CFS, Migraines, Fibromyalgia, Osteoarthritis, IBS, GAD, and Depression. When I lived in a small Eastern KY town my MD told me to make pain my best friend and wouldn't give me the pain meds I needed, because of DEA stunts just as described. There are a few bad doctors and more bad patients, but if everything is well documented then I don't see the problem. Now I'm in a bigger metropolitan area and getting barely enough to live on, but my MD here said it is getting harder to treat chronic pain due to crazy government restrictions requiring them to see the patient every month, which limits the number of patients they can have because it leaves no room for new ones. It is a no win for people like me who have worked hard all our lives, now we have to be in pain the rest of the time. I can no longer work(no social security yet either 3 yrs now), clean house, play with my grandchildren, or shop due to any exertion making the pain so much worse I can't move for 2 or 3 days. If we quit letting big government give all our tax dollars to study animal sex or pay immigrants to come over here and have 5 American babies for us to feed, then the pain they would feel from the lobbyists might make them open their eyes.
Anonymous
Brian
1/12/07 7:37pm
The US medical system does an abysmal job of pain management. Nowhere is this worse than in terminal care, where problems from addiction are moot.
Anonymous
Bill
1/13/07 7:37am
the people at DEA should suffer the pain then they might learn to understand the purpose of pain medication and what is real criminal acts vs. desperate need for pain relief. And any doctor who doesn't treat the patient should lose their license.
Anonymous
Robert Engelbardt
1/13/07 4:05pm
For people having problems receiving a sufficient amount of narcotic medication from their regular physicians to control their chronic pain, I suggest that they search for a pain management clinic or a physician who specializes in this field. They are generally more experienced in dealing with the drug control authorities. In addition to being able to more freely write narcotic prescriptions, they can offer advanced chronic pain control treatments such as an implanted morphine pump which can provide relief at much lower doses of narcotic medications because they are applied directly into the spinal canal. Pain management specialists may also be aware of drugs for pain control that may be more effective than the typically prescribed medications.
Anonymous
i m not a drug seeker need help
6/24/09 7:23am

What do you do when you have daily migraines and pain clinic after clinic refuse to take you because you are a "headache" patient.  I've been through about 8 now and a research University hospital just turned me down.  I need help and can't find it anywhere??

6/24/09 10:02am

I'm sorry to say that pain specialists generally aren't a good solution. Very few of them know much about Migraine and headaches. Their primary goal is to manage pain, but that's not the best goal of Migraine and headache management. With Migraines, it's just as important to prevent them as to treat the pain and other symptoms. Pain management specialists seldom know much about Migraine prevention, Migraine abortives, and total disease management.

 

It's important to note that neurologists aren't necessarily Migraine and headache specialists. Take a look at the article Migraine and Headache Specialists - What's So Special? If you need help finding a Migraine specialist, check our listing of Patient Recommended Migraine and Headache Specialists.

 

Hope this helps,

Teri

Anonymous
Anonymous
11/27/09 10:08pm

Do we have any rights when these clinics turn us away?  I'm tired of being treated like a drug addict when I need a pain shot for my migraine flairup.  I thought it was illegal for someone to turn you away for medical treatment.

Anonymous
Gretchen
1/16/07 1:02pm
The Miss. State Board of Medical Licensure sent a warning letter to doctors a couple of years ago. My internist (primary care) doesn't prescribe opiods in his practice. He had one patient get out of control, and he has decided to refer a patient to a specialist who will treat the entire pain-causing condition. It's been inconvenient at times, but I respect him for it. My neurologist will not call in opiod refills or prescriptions. They have to be mailed or picked up at his office. He now gives me 30 Hycodan a month, but when he was prescribing Lorcet, it was a once-every-three-or-four months deal. He was worried about acetaminophin toxicity. A pain, because if I was calling, I was in the middle of a monster that hadn't responded to a triptan and was in no condition to either drive or wait 2 days for a prescription to grind through the cross-town mail.
Anonymous
SHARON
1/19/07 11:11am
i am so mortified that richard has to spend 25 yrs in prison for doing nothing but waking up one morning and finding out he has a disease that will not only leave him in need 24/7 but will live in chronic pain the same 24/7. why am i so intensely angered? i too suffer from chronic disabling intense pain 24/7 and have done so for these past 38 yrs but more so in the past 16 yrs. my life too has been turned upside down. one moment you are vital and running around and the next moment you can not get out of bed or move one single inch due to horrific horrendous searing pain. have you ever sat on the burner of your stove or decided to lie on your barbeque? i think not, but we who suffer this pain feel as though we are on those burners and we can not get off them. how dare the government choose to do this to us the people who make this country what it is today. how many of them live in pain and take these same drugs. i am so mad there is not words for me to describe my total feelings. thank you for listening.
3/ 3/07 3:42am
I KNOW the doctors take into consideration the DEA. It is an outrage that they have to check with them before taking proper care of a patient in any kind of pain. This has been intolerable for a few years now. It is still easier to get drugs around the corner where I live in a town of 3000 than to get a doctor to give me what I need. The police stopped arresting the drug dealers even after I kept calling and calling and went for the easy ducks. The doctors who were trying to help. I've had too many doctors tell me upfront "don't ask me for pain meds". That, before they even knew what I was there for which happened to be a kidney stone! I understand how they feel. Why they aren't complaining more I don't know except they are afraid to stick their heads above water and draw the attention of the DEA to them. The DEA is running the medical situation is this country. That should not be allowed. Other countries think we have gone insane with this.
Anonymous
Anonymous
3/13/07 8:37pm
11/14/07 7:20pm

What A shame! It seems that all doctors are in fear of prescribing too much pain medication because of prosecution. why do people need too suffer? Not all people abuse medication! Doctor generally don't over- prescribe just a few "bad apples".

 

JW

9/23/08 8:42am

Rob, I am so happy you wrote on this subject.  I am so angry and don't know who to write about this.  On my last visit to the ER, I was told that my chart has been flagged.  They would no longer be able to give me a narcotic to help with my pain.  I wouldn't go there until my 3rd or 4th day of being on a 9-10 leval of pain, and exhausted all my other migraine medications.  I am very careful with my medications, as I do not want to go into rebound.  I have daily migraines, that I stay at a pain leval of 4-5.  I do not take anything unless I start going higher then that.  I did average going to the ER every 12-14 days.  I see Dr. Young in Phili, which he is aware of how often I was being treated.  Apparently, because I was prescribed percocet for a torned rotater cuff, I was considered a drug seeker.  I had taken only one, which I explained to the Dr.  They also can cause rebound headaches, and I was afraid to take them.  I was also scheduled for surgery for my shoulder, and only took 4 percocet then.  As you can tell I am not a person to take narcotics.  This flag was done from what I understand through pharmactical, I guess federal.  The pharmicist does not even understand from looking at my meds, why I was reported.  He said it does make it hard for my dr's to give me any medication.  This is so unfair, and really angers me.  I know there are people out there that want the drugs, and we only want releif from the pain we are in.  There has to be help, and I feel they have gone over board.  I am so sorry for going on and on, but this is a very sore subject with me.  Dr. Young did write me a prescription of Nubain, that I can give myself when I am in bad shape.  At least that will bring it down some. Thank you for writing on this subject.  I have wanted to, just didn't know where to begin.

Have a good day & pain free!

Debbie

Anonymous
j davis
7/23/09 7:29pm

Sadly many pain patiens are sent to 'pain clincis'  where thay are subject to new age psychobabble and taught 'acceptance' of pain instead of being treated properly. We can all thank the cowards and sociopaths of the DEA for this situation! Many legitimate undertreated patients have been 'red flagged' simply because they seek relief fron intractable pain. If they are 'lucky' enough to reach a pain clinc they are subjected to humiliating pain 'contracts' and suspicionless urine tests. Fortunately where I live there is a thriving black market and should I find myself in this unenviable situation I would not hesitate to avail myself of there services.

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