Dr. Suzanne A. Salhab, is a multi-specialty Medical Physician, board certified by the American Board of Family Medicine, American Board of Multi-Specialties, and Board Certification in Addiction Medicine by the American Board of Addiction Psychiatry and American Society of Addiction Medicine. She recently opened up a brand... more
I may have a substance abuse clinic that treats 'addiction' but that's only because that's how things are labeled in society today when you think of the word 'addict'. Addiction is just a habit; it can be good or bad. Some people are addicted to Coke Zero, so whats the difference? A habit is a habit. I get that drugs are bad, but so are many other things, like going to a buffet 7 days a week.
Why are 'addiction' and 'addict' used to refer to patients that are on medications? Alcoholism used to be an addiction and now it's a disease? That doesn't make sense. Hypertension, diabetes, etc. are diseases. The others are just substance overuse if they do too much of it.
There are so many things that factor into the game. On one end you have guidelines, opiate-naive vs opiate-tolerant, so right there you are telling me that the patient will become tolerant. Therefore, once becoming tolerant, if you ask for an increase in meds because you're "physically dependent," you're an addict? But, I knew before putting you on it that you'd need an increase in dose. So did I make you a so-called addict, or is it that the word 'addiction' should not even be used? Both.
I have seen physicians that have prescribed horrible regimens: One month on methadone, the next month on Percocet, the third month on oxycodone, the fourth month on Tylenol 3—then they say "It's in your head. Here's 6 mg of Xanax." So great, make the patient go through withdrawal, and place them on a Xanax that's short acting. It's not the patient's fault; it's the doctors. Anything short-acting comes back with a vengeance, so once a dose of Xanax wears off, it's called 'rebound anxiety', so you take another pill. That's called 'Doctor-induced addiction'. You have all these pain management clinics that do not know how to properly prescribe medications, and we wonder why so many people are on horrible regimens and can die.
I've seen it! Methadone is not a 12-hour drug. And Fentanyl patches people don't work on skinny patients! I've had three patients in my office all on the patches that weighed 115 pounds, and the mechanism is, if you don't have fat, it will not work. And the doctors prescribing it are so-called surgeons. Honestly, I think it's because they are too damn lazy to do prior authorizations, and I'm a doctor who does them—it's not that hard! They'd rather make them continue to come back, and continue to feel pain so that these "pain management docs" can give them a nerve block because the patient's pain is excessive and on the max dose of Fentanyl.
Smart, right? Give them a med that doesn't work, they keep coming back because they have no idea and get shots, so now you can charge their insurance $900. The same physician who diagnosed a patient with complex regional syndrome placed her on an IV ketamine drip and then referred her to psych (a referral to psych means it's all in the patient's head), but you put them on a ketamine drip? How does that work? Oh, it's because you get a few grand, right? Just like I said, it's called opiate-tolerant; eventually you should realize that the patient has been on the same dose and quantity for months, and if they are in pain, be a real doctor.
How is it that I'm so young and pain management became a specialty years later, but I seem to know more than a pain management physician that did a fellowship in it? Again, it's all about the money. Let them be in pain; give them shots.
So do you blame the patient in pain? The one who goes on the streets to get meds? It seems like Doctors caused this overdose garbage and stigma. But then, you have Doctors that just over-prescribe and kill a patient, and then doctors who judge even physicians as "druggies" even though we have a drug monitoring program and absolutely refuse to help patients that are in need.
So, again, do you blame patients for getting meds off the streets? Would you go see a doctor if he or she make you seem like an abuser? Of course not, but it's a pick-and-choose world. The medical boards says to treat pain adequately and it's case by case. The DEA goes to pharmacies and literally terrorizes them about meds, so then it's another situation—how the patient gets their meds. "Oh, we are currently out" is what a patient got told. Now, keep in mind the person working there did not turn and go get it; it was a reflex. So we treat pain correctly, and now pharmacies are too scared because the DEA can do anything but terrorize them.
When there's chronic pain management due to high risks of surgery, you should have that medication in stock. The harder you make things accessible, the more other things are going to be misused, diverted, etc. It's funny how if you pee in a cup with a result of opiates, it's a felony, but these meds stay in your system. An illegal substance gets you down to a misdemeanor. And how is that medical marijuana is still illegal? It's easier to get than opiates now! And why do you think they passed the law, because its risks and benefits are great? No. If you go read the brand new Florida consent form, it talks about how there's no evidence that medical THC improves any of the qualified diagnosis. What?!
My thing is, if you make anything hard to get, people will go looking for it. That's how life works. Is is the DEA, who talks about the opiate craze, the reason it's happening? Why don't you let things be, especially when the overdose rate increased significantly during 2015-2016, when it became hard to get prescribed and get it? Therefore, who knows what patients were buying on the street?
So, a huge solution: Treat patients, don't call them addicts, and don't put them on garbage meds. It may solve things. Or, keep dong what you're doing and pretend that it's not the big people upstairs that are doing this. Pretend it's the patients, or the "pain management" physicians that can give spinal blocks that don't get monitored like meds, but just charts. For the patient, go to a legitimate clinic like an institute so no one calls your place a 'pill mill,' and keep going, only for you to be placed on meds that don't work and get epidural blocks.
Again, it's smart if you're money-hungry. It's crappy if you're a physician. It's doing harm to a patient, and the DEA/boards don't give a damn. What's worse is that when patients with a history of rape, trauma, PTSD, etc. do not get help, do you blame them for wanting to forget about their problems and take something that will basically knock them out? I don't, especially with healthcare these days.
No one knows how to treat mental health; physicians are no longer compassionate. Why? Is it because of insurance? Who's starting this big huge cycle? All I know is that it's the patient that faces the consequences; it's the good physicians that get smacked on the hand; it's the crappy docs that go home rich, ruining lives, and it's the boards and people in the higher chairs that are watching this and don't really care.
Please be careful and do not call anyone an addict, as this can cause a great deal of harm and make them use substances. Stop criticizing people and look at yourself. I am sure someone can judge you on many things. So I say, keep your comments to yourself. If you don't know how to treat it or why it's happening, don't give your advice because you're honestly not entitled to do so.