Biotech Values

[apljack]

Semi OT: opioids and physician liability

"In case you missed it, this is a lengthy on-point article from 2007: #msg-20522244. Regards, Dew"

A damned interesting article, I must say. It indicates that my experience really just scratches the surface of aggressive pain management with opiate medications. The convicted doctor in question was prescribing 800 mg. of oxycontin a day with an as needed addition of up to 720 mg of roxicodone for breakthrough pain (and xanax to boot) to the patient who died. I found it interesting that the article author made no attempt to ask any expert about those specific doses for a patient, naive to the medications or not.

To put this into context, most patients in pain management settings that I see are prescribed between 40 and 80 mg. of oxycontin, methadone, or some other opioid per day. Oxycontin is psychoactive at 5-10 mg per dose for the opioid naive subject. Most drug abusing subjects speak of the sustained buzz of oxycontin without the upset stomach side effects. I haven't asked patients (in other contexts, mind you) about the street value of a 10 mg dose of hydrocodone (vicodin) in some time, but last time I did, I believe that each of these pills was worth about $10. A quick check with google indicates that this is still the case.

I have yet to see the civil litigation that follows the criminal/DEA investigations of doctors suspected of misusing their prescription pads in this way. Prudent medicine should lead pain management physicians to confer more with the like of my ilk, as neuropsychologists have uniquely distinguished themselves by developing objective tests for malingering/secondary gain and/or manipulated effort, but most doctors I talk to describe "not wanting to rock the boat" which can be read to mean that they know they are de facto drug dealing, but in a way benign to their practice and with no complaint from their patients.

aj