The Opiod Epidemic

[panamaican]

yeah, I know you do, I find it annoying that you are using legal interpretations of commonly understood words to discuss this topic amongst laymen.

And it does apply when these medications are prescribed with conscious, voluntary, and reckless regard. See the case of Hsiu-Ying Tseng that I linked above for an example of this.

I think you need to re-examine professional responsibility if you think prescribing 180 oxycodone 30mg to a patient because they complain of pain is acceptable because the prescriber is treating the patient "like an adult".

I'm using legal interpretations because people are assigning legal consequences to the laymen's terms.

Professional responsibility, for example, is a legal term. People can't jump back and forth between claiming some legal responsibility attaches to the doctors based on laymen's sense of responsibility.

If you want to keep it on the laymen's level then that's fine. The doctor is not responsible for what the patient does with a perfectly valid script after the patient leaves the office.

 

[panamaican]

Source?

Math.

 

[HomeCheese]

You need to remember that 20 years ago more providers were getting into trouble for under prescribing then were getting into trouble for over prescribing. Another issue is how cheap and available heroin is. A provider can reduce a patient's prescription and then the patients try to buy their oxy's on the black market which can cost $60-$80 a pill. Then they realize they can buy a whole bag of heroin for $20.

 

[Anung Un Rama]

I'm using legal interpretations because people are assigning legal consequences to the laymen's terms.

Professional responsibility, for example, is a legal term. People can't jump back and forth between claiming some legal responsibility attaches to the doctors based on laymen's sense of responsibility.

If you want to keep it on the laymen's level then that's fine. The doctor is not responsible for what the patient does with a perfectly valid script after the patient leaves the office.

Its not valid if its an example of prescription fraud.

 

[Anung Un Rama]

Math.

So nothing to back it up. Gotcha.

 

[panamaican]

Its not valid if its an example of prescription fraud.

If it's actual fraud then it's already criminal. But that's going back to legal terms.

 

[panamaican]

So nothing to back it up. Gotcha.

No, take the number of doctors, the number of patients, the number of scripts written, the number of lawyers, the number of lawsuits where the doctor is found guilty, the number of doctors suspended or disciplined for script issues. Do the math. Rarely occurs.

 

[Cubo de Sangre]

We do hold script writers accountable for when they do something wrong. Not for when the patient does something wrong.

You're a 2nd Amendment guy, as am I. This is the same thing. A guy legally sells a gun to someone with no reason to believe that the buyer is a psycho. We don't hold the seller responsible for when the buyer eventually does something stupid. People who try to restrict the 2nd Amendment constantly make that argument and I find it absurd. It is just as absurd here.

A doctor cannot determine if the patient in front of him/her is going to eventually become addicted. They can't determine who will intentionally disregard the treatment instructions or who will sell their drugs on the black market for personal gain.

The car dealer cannot determine if the buyer is going to drive drunk 3 weeks from now or text and drive or any myriad illegal actions that people take behind the wheel. We don't say "Well, people shouldn't sell cars."

There's a point where doctors are responsible (if they know that the patient is lying about their injuries or the doctor writes a script knowing that it's unnecessary) but 99% of the time, responsibility lies with the patient. And if they start thinking they have a problem - they should go get help. Every single one of those legal drugs warns about potential addiction.

And none of that has anything to do with the people who are hooked on heroin and looking for other ways to meet their addiction.

Thanks. I understand exactly what you're saying. And again, I'd let people medicate themselves. Although doctors would still have a professional responsibility to give you good care and advice.

How do you reconcile this position with your support of drug prohibition? That stance implies you believe people are not responsible enough to be trusted. Additionally, those that provide the drugs get the harshest sentences. Don't recall you ever saying dealers shouldn't be punished for the choices of others.

 

[Anung Un Rama]

If it's actual fraud then it's already criminal. But that's going back to legal terms.

Well, you used "valid", which is also a legal term, so I felt it necessary to disambiguate a prescription legally written by a prescriber with a DEA license and a prescription written for a condition that doesn't exist, or exists, but not warranting the medication and/or medication quantity and refills prescribed.

 

[Anung Un Rama]

No, take the number of doctors, the number of patients, the number of scripts written, the number of lawyers, the number of lawsuits where the doctor is found guilty, the number of doctors suspended or disciplined for script issues. Do the math. Rarely occurs.

Thats not how this works.

 

[panamaican]

Thanks. I understand exactly what you're saying. And again, I'd let people medicate themselves. Although doctors would still have a professional responsibility to give you good care and advice.

How do you reconcile this position with your support of drug prohibition? That stance implies you believe people are not responsible enough to be trusted. Additionally, those that provide the drugs get the harshest sentences. Don't recall you ever saying dealers shouldn't be punished for the choices of others.

I don't support drug prohibition or legalization. I support the reality that drugs are currently illegal at the federal level and the law should be followed. If the government makes drugs legal then that law should be followed as well.

Right now, selling certain drugs is illegal under specific circumstances. Selling other drugs is legal under specific circumstances. If people don't like the laws, get them changed. Don't complain about the consequences of existing law.

 

[Gregolian]

Its not valid if its an example of prescription fraud.

Isn't prescription fraud just when someone goes in an basically gets an illegal script? Like college kids finding the one doctor in town that will give them an adderrall script around finals.

 

[panamaican]

Well, you used "valid", which is also a legal term, so I felt it necessary to disambiguate a prescription legally written by a prescriber with a DEA license and a prescription written for a condition that doesn't exist, or exists, but not warranting the medication and/or medication quantity and refills prescribed.

I preceded valid with stating that we're using laymen's terms. Justifiable. Reasoned. There's no fraud if it's valid.

And if the doctor writes a valid prescription, valid in the doctor's opinion, then the responsibility lies with the patient. Again, laymen's terms.

 

[Anung Un Rama]

Isn't prescription fraud just when someone goes in an basically gets an illegal script? Like college kids finding the one doctor in town that will give them an adderrall script around finals.

It is also when a prescriber writes prescriptions without a legitimate purpose.

 

[Gregolian]

I don't support drug prohibition or legalization. I support the reality that drugs are currently illegal at the federal level and the law should be followed. If the government makes drugs legal then that law should be followed as well.

Right now, selling certain drugs is illegal under specific circumstances. Selling other drugs is legal under specific circumstances. If people don't like the laws, get them changed. Don't complain about the consequences of existing law.

Basically don't pull a Nick and Nate Diaz whining about pot but all they do is whine.

 

[Gregolian]

It is also when a prescriber writes prescriptions without a legitimate purpose.

Guy comes in with pain issues and you diagnose a pain concern and prescribe pain pills with a direction of "cease use when no longer needed" on the label (which my pain meds had after being discharged from the hospital) it's out of the doc's hands if the patient keeps using them after they need them.

 

[panamaican]

Thats not how this works.

That's exactly how "rarely" works. The frequency of the occurrence relative to the total population set.

For example, despite the media's obsession with gun violence - it is rare that someone is actually killed via gun related homicide. Less than 1 in 1000. That's rare. The rarity doesn't change just because the magnitude of the consequences is high.

Criminal prescription writing rarely occurs. It's rarely prosecuted because it's extremely uncommon. That doesn't mean it never happens, of course it does. But not to the degree where anyone can realistically argue that doctors are somehow responsible for some larger societal trend.

 

[Anung Un Rama]

I preceded valid with stating that we're using laymen's terms. Justifiable. Reasoned. There's no fraud if it's valid.

And if the doctor writes a valid prescription, valid in the doctor's opinion, then the responsibility lies with the patient. Again, laymen's terms.

And when a prescriber is irresponsible in writing prescriptions that he knows are not valid, or even suspects they may not be valid, then he/she should be held accountable.

 

[Anung Un Rama]

That's exactly how "rarely" works. The frequency of the occurrence relative to the total population set.

For example, despite the media's obsession with gun violence - it is rare that someone is actually killed via gun related homicide. Less than 1 in 1000. That's rare. The rarity doesn't change just because the magnitude of the consequences is high.

Criminal prescription writing rarely occurs. It's rarely prosecuted because it's extremely uncommon. That doesn't mean it never happens, of course it does. But not to the degree where anyone can realistically argue that doctors are somehow responsible for some larger societal trend.

Or is it rarely prosecuted because its underreported and difficult to prosecute? You don't know how often this occurs.

 

[Anung Un Rama]

Guy comes in with pain issues and you diagnose a pain concern and prescribe pain pills with a direction of "cease use when no longer needed" on the label (which my pain meds had after being discharged from the hospital) it's out of the doc's hands if the patient keeps using them after they need them.

How long have you been practicing medicine Grego?