“The Coroner is on the phone.”
At these words, my stomach clenches into a ball, and my hear pounds. Immediately I think: Which patient? What happened? Did I miss something?
Often times, the call is about an elderly patient that died peacefully at home. This last week the call got me analyzing a major issue in my practice and medicine in general.
KD was found dead at home. She was in her 50s. She was ill and needed chronic pain medication for her disease. She took a lot of Oxycontin. While the final forensic results won’t be in for a long time, in my gut, I know it had something to do with the Oxycontin.
The dangers of narcotic pain meds are so enormous and yet often overlooked by patients and doctors alike. On the other hand, people are living with chronic and debilitating pain every single day. Is it fair to withold medications from a woman with Stage IV rectal cancer because she may misuse it? Or, do we prescribe freely and put the responsibility on our patients to follow instructions to the letter?
Then, of course, there is the issue of addiction, and the enormous street value of these drugs. A young man “in the know” told me once that an “Oxy” goes for $20 on the street. So, my script for a one month supply of 60 tablets is worth $1200!!! That is a lot for any one in a financial bind—or desperately needing a fix they can’t afford.
The actual number of unnecessary deaths from these drugs is a hard one to figure but all would argue it is too high.
I have thought about having a rock solid policy where we don’t prescribe any narcotics ever in my practice. That is not reasonable, practical or fair to my patients who need these medicines for appropriate conditions.
I have devised a pain management contract that all patients on these drugs must sign–as of now, that has not gone over well with patients.
I look every chronic pain patient in the eye when we are dicussing threir meds. I try to read them. I try to pick out the few that might be in danger of over/misusing. But, clearly, that approach has been next to worthless. I either miss the signs all together, or my patient gets the feeling that I don’t trust them.
I believe the answer lies much deeper than the policies and practices of one small practice and a few patients. We need a grass roots effort in this country educating doctors and patients alike about these dangers. In that effort, we need to understand how to balance the dangers against the sense of ostracism these patients have.
After my last C-section, my doctor gave me a script for Percocet. I was mortified handing the script to the local pharmacist and actually contemplated driving further away so they “wouldn’t know me.” And, this was a one time script, for about 10 pills. It wouldn’t raise anyone’s flag…but it sure raised my own.
Is it enough to stare someone in the eye and try to read their intention, understanding, and true need for these drugs? Or do we swing full circle and stamp our feet and “Just Say No?”
Are you on Oxycontin or other pain medication and want to share your story? Do you know someone that had a problem with pain medications whose story we may learn from? Please share your comments anonymously below. Clearly a conversation needs to happen–before I have to have another one with the county coroner.