Tuesday, February 10, 2009


The pain got its hooks into me bad over the weekend, and so, after a sleepless Saturday night, I slapped on a fentanyl patch before T.'s birthday party. (It was not the prospect of her friends that drove me to narcotics, I swear.) 

I discussed the move with my doctor on Monday, received a prescription, and I will be using the patches for the foreseeable future. This has some downsides -- during my previous stint using this medication, I quickly became physically dependent on the drug, so much so that if a patch slipped off accidentally, I would soon start feeling sick and nod off -- but offers the powerful lure of being able to sleep and function better. 

I was feeling pretty good about the decision, then I read an article titled F.D.A. to Put New Restrictions on Narcotics:
Many doctors may lose their ability to prescribe 24 popular narcotic medicines as part of a new effort to reduce the deaths and injuries that result from these medicines’ inappropriate use, federal drug officials announced Monday.
Cut to an exaggerated Jon Stewart "oh-oh" face here.
Hundreds of patients die and thousands are injured every year in the United States because they were prescribed drugs like OxyContin or Duragesic inappropriately or they took the medicines when they should not have.

The toll has worsened in recent years, with the blame shared among doctors who prescribe poorly, patients who pay little attention to instructions or get access to the medicines inappropriately, and companies that have marketed their products illegally.
Cut back to Jon making his horrible news face.
But many doctors prescribe the drugs far too cavalierly, Dr. Jenkins said. For instance, most are intended for use only in patients suffering severe illness — like end-stage cancer — who have already become so acclimated to opioid therapy that they still are in pain.

The F.D.A. has received reports, however, of patients suffering from something as simple as a sprained ankle being prescribed such medicines, Dr. Jenkins said. In such patients, the medicines can be dangerous.
Ugh. While this is probably a wise move from a public health perspective, I feel like it feeds some of the counterproductive ambivalence patients and even health care providers have about these drugs. I, for example, am not particularly acclimated to opioids. It's just that low doses of dilaudid, which have about three hours of active life in the body, are a poor match for chronic, grinding pain. My only hope for relief right now is taking some sort of stronger, extended-release narcotic and dealing with the attendant downsides. Don't stigmatize me! I agree on one point, however: Any doctor prescribing this stuff for a sprained ankle is a jackass.

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