Medicine shouldn't be practiced in a manner where "the customer is always right." Turns out people actually don't always know what's best for them.
Nice article illustrating that point from AIM this year:
link to abstract
And nice commentary on the article on the blog KevinMD:
link
Does a substance abuser lose the right to have their pain treated?
Yes, appropriately, which often times is not with narcotics.
Do we treat pain regardless of the cause or do we make a moral decision on who is worthy and why?
Yes, but you treat it appropriately. Narcotics are not the answer for everything.
Do all ambulances have other alternatives between a narcotic and nothing?
As food for thought,
Anesthesia in surgery allows providers to inflict damage upon the body. (Under the intent that the damage inflicted is more beneficial than not inflicting)
Is it ok to inflict social/psych damage and not offer analgesia?
I'm not sure what you're getting at here. But I'll say yeah, but to me "analgesia" would be therapy, rehab, social services, etc, etc.
Excellent, can you write a prescription for inpatient rehab for people who have no money?
A prescription to give an unemployed person a job?
A prescription to solve family problems?
A prescription for a better education?
A prescription to seal a criminal/arrest record?
A prescription for affordable day care to a single parent?
Nobody can. For certain those would be good solutions to help people get away from using drugs to escape the pressures of social affliction. Whether it is alcohol, nicotine, or something more illicit, people predisposed to harmful coping mechanisms of any sort will usually succumb to them and when they do, as in the case of prescription drug abuse, vs. street drug abuse, I know that restricted access doesn’t stop people from abusing drugs, it just forces them to abuse what they have access to. So in order to maintain their individual coping mechanism, should they lose access to a prescription, then they are forced to go to the street. Which creates a new set of problems and can actually worsen the plight of “functional” abusers.
How many drug abusers will actually undergo reform and become productive members of society?
I don't know about Europe but here, very few, doesn't mean I should become thier dealer.
It has very little to do with location, only the type of substances change. But the cheap home cooked stuff vs. the more refined substances are of little consequence to this discussion. Becoming a dealer, sounds to me like a moral stance. In my opinion, personal morals are tricky things to introduce in medicine.
After all, what is really the difference between using an opioid pain killer or a neuroleptic in order to deal with anxiety, depression, etc?
While it may seem like intent, or mechanism of the drug, it is the same outcome, in the US until most insurance and government programs will not pay for psychiatry and ongoing psychology treatments they will pay for opioids.
Of course I doubt the usefulness of this alone without social support to solve the underlying cause, which of course is practically nonexistent. I am not sure I agree with the moral compass of “Let them die,” as postulated by supporters of one political party.
What drives the ones who do? Do you really think it is lack of access to thier substance?
No. I would say it's unique for each person, but ultimately has to be an internal drive.
My point exactly.
If it is ok to palliate people with terminal illnesses, what makes it so reprehensible to palliate people with social/psychiatric affliction?
It's not reprehensible to "palliate" social/psych afflictions, but again, throwing narcotics at a known addict isn't the way to go about it.
I am an operations type guy, I like to know how things are actually going to work. I agree there are better solutions than throwing narcs at an addict, but what are the practical things that can be done in the US today? Especially in Ohio, where I am from originally and worked many years?
What is your better way that you can implement today?
Outpatient methadone is beyond outrageous, let me tell everyone how it works. Addicts get their methadone in order to help control withdrawal symptoms until they can get a some menial job or until a government cheque comes in so they can score something that they want.
It is an observable mana economy right in the US midwest, you can actually predict the types of ER visits related to drugs and violence by the approximate date of the month.
There is a difference between customer satisfaction and taking care of drug abusers by maintaining what little quality of life they have.
While many physicians would like to think that giving people the optimum quality of life is the undisputed goal, it is out of the capabilities of medicine to do so.
Not everyone is going to lead a middle class or upper class life. Not everyone is going to be able to eat healthy. Not everyone is getting an education. Not everyone is going to live to be 100. Not everyone is going to be able to cope with their position in life and society in a positive manner. But imposing morals on them or refusing to help when they do not match your own, makes for a rather poor physician in my mind, or a poor provider at any level.
There are physicians I have met that believe they are only around to treat the more "upstanding" members of society, by doing next to nothing and complaining all the while when dealing with lower class people. One even pawns those patients off to her PAs, but I honestly don't think too highly of those physicians.
As unpalatable as it may sound, giving somebody a narc script so they can go on abusing is a much more humane way to take care of somebody to the best level they can expect, as opposed to forcing them to turn to street drugs, prostitution (both men and women), and crime in order to get their fix.
Does forcing somebody into those predicaments count as looking out for their health or best interest? Perhaps there is a study or a blog with an opinion on it?
