Protecting the Patient
Protecting the Patient
I am increasingly attracted to the idea that we could diminish drug abuse by prescribing more opiates, by giving our patients the quantity that they request for relief of their pain.
A back painful 55 year old widow came to me requesting my assistance. Her primary care physician had been treating her, prescribing hydrocodone in a dose of 10mg, twice daily. As her pain became more severe she requested a larger dose but her physician refused.
I can only speculate as to why. The dose she was taking was quite small and the dose she requested, four pills daily, was by no means extraordinary. Perhaps he was trying to protect her from addiction, or perhaps he was protecting himself from investigation from the State Board of Medical Examiners. Regardless, he was treating his patient to tthe level of his comfort and not to hers. That is not what we doctors are supposed to do.
I asked my patient, as I am wont to do, if she ever took more than the prescribed dosage and she acknowledged that she frequently did. I asked her where she got the extra medicine and she said friends shared it with her. I then asked her if she ever bought the drugs off the street. She hesitated, and then said "Are you trying to get me in trouble?"
"No, you can trust me but I do want to learn something. You do buy the hydrocodone off the street."
"Yes, I do."
"How much do you buy in a month?"
"Sometimes 30, sometimes 40."
"How much do you pay for them?"
"I pay eight dollars a pill."
"That's $240 to $320 a month. Is that correct?"
"Yes, that's correct."
"Do you know the person you are buying them from? Do you see him or her personally?"
"You're really trying to get me in trouble. I am not going to tell you his name."
"You don't have to and I am not trying to get you in trouble but you know him personally?"
"Yes, I will meet him at a certain location and buy the medicine. I would never have them delivered to my home."
"Where does he get the hydrocodone?"
"There is a doctor in Arkansas that writes him tons of prescriptions. He brings them to Tennessee, gets them filed and sales them in my hometown. It is very easy to get the medicine off the street."
Now let's go back to the primary care doctor who would only give two pills daily of hydrocodeone, 10mg. Let's be fair to him. Maybe he was protecting her from addiction and protecting himself also. And let's acknowledge that he did not make her a criminal but he did make her decide between suffering and becoming a criminal. She elected, not to suffer so she engaged in the illegal activity of purchasing controlled substances, this at a cost several hundred dollars a month of her widows pension. That is vastly more than the drug would have been prescribed and purchased legally.
In the process of all this our patients prescribing physician was actually encouraging the illicit sale of drugs and the illegitimate prescription of drugs by an illegitament physician. If he had but prescribed the requested amount of 4 pills daily, the widow would have $240 to $320 dollars each month and the drug dealer and the illegitimate physician would make one less obscene profit.
Think about it.
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