Opioid Crisis! Alarm! Panic!

 

The opioid crisis has struck America. I know, because my health insurance has notified me of such. It’s Cigna’s “goal to offer access to coverage for safe, effective and affordable medications.” They want me to know that starting July 1st, they will restrict my coverage to amounts that they consider to be safe.

I was shocked, just shocked, to see that “accidental opioid overdoses reportedly kill more people than car accidents.”

Thank God Cigna is there to save me from myself!

I mean, with my Butalbital-ASA-Caffeine that I take rarely for migraines, it’s so important that they prevent me from taking it frequently. Also, without this letter, I never would have known that it was a narcotic or opiate. Butalbital is usually classed as a barbituate, but who am I to judge? This letter explains to me just how dangerous all of this is!

Thank God that they are here to save me from myself and my appropriate medical knowledge.


Coming to a mailbox near you: coverage limits on drugs that will be reclassed as “opiates” simply because the insurance does not want to cover larger amounts and does not want to be responsible for potential overdoses. I wouldn’t be so outraged if the Pharm D. who signed this inane form letter had a specific provision stating that not all medications in this were opiates, but were going to be subject to increased oversight. It particularly irks me that their Chief Pharmacy Officer is spouting information from Cleveland Clinic and is being completely indiscriminate. Less educated people would just accept that they had somehow been on opiates all this time and simply did not know. I consider this letter to be an example of bad faith and inappropriate education, bordering on fraudulent misinformation. It increases panic and increases the stigma for people who happen to use and need opiates for pain control.

Just be aware. Misinformation is not just on the news anymore.

Published in Healthcare
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  1. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Midget Faded Rattlesnake (View Comment):
    Labor pains weren’t so bad.

    …until I realized that induced labor felt exactly the same as every other g-d month.  Somewhere someone’s getting an epidural for the stuff I live with at least once a month.  Awesome.  Not.

    • #61
  2. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    TheRightNurse (View Comment):
    Most of the time I can handle terrible pain (as long as I’m not expected to function!).

    That’s exactly it!

    Want me a non-functional human being? I can endure pretty much anything while being that! Want me to function as something approximating a productive member of society, though?…

    Chris Buckley, in writing of his father, William F, described his father’s craving for “work drugs” in his declining years. In the quest to squeeze the very last drop of productivity out of his remaining life, WF was willing resort to pharmaceutical means.

    I hardly require drugs to goof off and be useless – I’m quite capable of that stone-cold sober, alas. I’m pretty firmly in the mindset that the reason to treat discomfort is so you can do things that otherwise wouldn’t get done. Which means there can be a lot of not-necessarily-productive guilt involved when work’s still not done despite good symptomatic treatment. But I suppose that still beats intending to use drugs to be more (rather than less) of a bum.

    • #62
  3. JLock Inactive
    JLock
    @CrazyHorse

    Midget Faded Rattlesnake (View Comment):

    TheRightNurse (View Comment):

    Chris Buckley, in writing of his father, William F, described his father’s craving for “work drugs” in his declining years. In the quest to squeeze the very last drop of productivity out of his remaining life, WF was willing resort to pharmaceutical means.

    A slippery slope this road. The brain circuitry is already hard wired to reward productivity of work with dopamine. Reinforce that with a chemical that binds to the same receptor — and that’s how great lives are ruined. I’m not saying that’s your case — this area has recently been targeted in the genome and the genetic carrier for addiction.

    Strangely, it’s one that can easily lie dormant or become Schizophrenia and possibly MS.

    My Moms debilitating alcohol and drug addiction, one that would spiral out to her suicide, has made me intensely aware of my potential for abuse. And while I went through a drinking age where I was heavily soused — I’ve avoided scheduled drugs like the plague. I can have manic episodes but my down time is too short and not deep enough to qualify bipolar diagnosis. Still, I know opioids would be my certain death.

    • #63
  4. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    JLock (View Comment):
    Still, I know opioids would be my certain death.

    There’s something to be said for the self-awareness necessary.  There are people who are unnecessarily afraid of opiates; family members who believe their loved ones (at the end of life!) will become addicted.  So what?  The person is dying.  Let them have their pain relief.  They will not live long enough to suffer the consequences of addiction.

    Then there are the others: people who simply do not care.  I have never experienced a high from opiates and I hope I never do.  There are those who would rather be completely beyond their wits than feel an ounce of pain.

    There really does need to be a correction of expectation.  People need to understand that life has an element of pain and that pain is an essential part of humanity.  If people feel the need to have zero pain, maybe there should be a psych consult automatically because these people have unreasonable expectation for others…maybe this also extends to themselves.  Maybe their need for a lack of pain comes from something else?  Maybe this is a good place to start.

    We seek to relieve pain.  If it is eliminated, great.  If it is reduced to a tolerable level, that is the goal.

    • #64
  5. aardo vozz Member
    aardo vozz
    @aardovozz

    Gary McVey (View Comment):
    On some level it always surprises me, a mere civilian, that when nurses go to the doctor, you have to deal with the same systems the rest of us do.

    This also happens when doctors see doctors now as well.

    • #65
  6. aardo vozz Member
    aardo vozz
    @aardovozz

    MarciN (View Comment):
    Can doctors override these regulations somehow for their patients?

    “This patient really needs this and I’m prescribing it and you’re paying for it.”

    Is that possible? Or are doctors too living in terror of some tyrannical computer in Washington yanking their license for writing a prescription not allowed for in the computer codes?

    We will all need our own drug dealers soon.

    These laws will be really good for the drug cartels.

    Most insurances have an appeals process for many categories of drugs they would not ordinarily cover. Doctors can go through this process for their patients if they feel it is necessary,but the insurance companies do make the doctors jump through a few hoops to do so,and it can sometimes take some time to get approval even after the doctors jump through the hoops. For controlled substances for pain control, most doctors I know usually refer patients to pain management specialists if the dose of pain medication required by the patient is more than the dose the doctors are comfortable prescribing. I hope this answers some of your questions,MarciN.L:)

    • #66
  7. Midget Faded Rattlesnake Contributor
    Midget Faded Rattlesnake
    @Midge

    JLock (View Comment):
    The brain circuitry is already hard wired to reward productivity of work with dopamine. Reinforce that with a chemical that binds to the same receptor — and that’s how great lives are ruined.

    I think in our family we are too much perfectionists to ever have gotten that dopamine hit to begin with, even as small children. We have to rely on some sort of abstract moral satisfaction, or masochism, or the sheer overwhelming guilt of not working hard enough, to keep going. In order for work to feel good, it would have to feel good enough, and it never is. Though, as bad as work feels because it’s never good enough, the shame of not working feels far worse!

    • #67
  8. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    aardo vozz (View Comment):

    MarciN (View Comment):
    Can doctors override these regulations somehow for their patients?

    “This patient really needs this and I’m prescribing it and you’re paying for it.”

    Is that possible? Or are doctors too living in terror of some tyrannical computer in Washington yanking their license for writing a prescription not allowed for in the computer codes?

    We will all need our own drug dealers soon.

    These laws will be really good for the drug cartels.

    Most insurances have an appeals process for many categories of drugs they would not ordinarily cover. Doctors can go through this process for their patients if they feel it is necessary,but the insurance companies do make the doctors jump through a few hoops to do so,and it can sometimes take some time to get approval even after the doctors jump through the hoops. For controlled substances for pain control, most doctors I know usually refer patients to pain management specialists if the dose of pain medication required by the patient is more than the dose the doctors are comfortable prescribing. I hope this answers some of your questions,MarciN.L:)

    One quickly tires of paying staff to make pointless phone calls intended to save patients a little money.

    • #68
  9. civil westman Inactive
    civil westman
    @user_646399

    Midget Faded Rattlesnake (View Comment):

    JLock (View Comment):
    The brain circuitry is already hard wired to reward productivity of work with dopamine. Reinforce that with a chemical that binds to the same receptor — and that’s how great lives are ruined.

    I think in our family we are too much perfectionists to ever have gotten that dopamine hit to begin with, even as small children. We have to rely on some sort of abstract moral satisfaction, or masochism, or the sheer overwhelming guilt of not working hard enough, to keep going. In order for work to feel good, it would have to feel good enough, and it never is. Though, as bad as work feels because it’s never good enough, the shame of not working feels far worse!

    I can take you to a meeting of Anhedonics Anonymous with me, if you want. It adds a whole new dimension to commiseration. It just may be that I used up my allotted  supply of brain “happy” chemicals earlier in my life. I function OK, but just can’t seem to do ‘happy’ much less ‘joy.’ Opioids would likely help, at least for a time, but I now have good judgment.

    “Good judgment comes from experience. Experience comes from bad judgment.” – an anonymous wise person.

    • #69
  10. Susie Inactive
    Susie
    @Susie

    I feel your pain TheRightNurse, I now have to pay for my Midrin for migraines. It has an analgesic, vasoconstrictor and a light sedative. Thanks, Insurance Overlords.

    • #70
  11. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Susie (View Comment):
    I feel your pain TheRightNurse, I now have to pay for my Midrin for migraines. It has an analgesic, vasoconstrictor and a light sedative. Thanks, Insurance Overlords.

    A sedative?!  I bet it’s an opiate!  Addicting and habit-forming, it clearly should be restricted!  My god, are you okay?  Are you sure you’re not already addicted?  I bet they have some online coaching for that…

    • #71
  12. Steve in Richmond Member
    Steve in Richmond
    @SteveinRichmond

    I appreciate the desire to limit the chances of addiction, but as mentioned in an earlier comment, there is a psychological piece to this as well as physical.  My main exposure to opiates was after hip replacement surgery.  I had some minor complications requiring a 3 night hospital stay.  The percocet they started me on was prescribed every four hours, but the pain came back after 3.  When I mentioned this to the Dr. he changed the prescription to straight Oxycontin at a higher dosage.  That worked great, until the 2nd night when the night nurse told me in no uncertain terms she did not agree with this dosage.  And then she wouldn’t give it to me.  Well, she didn’t tell me she wouldn’t give it to me.  She just made me wait 6 hours instead of the 4 I was supposed to, even thought she gave me other medications on time.  I felt no effects other than pain while waiting.  On discharge, I was given a 3 week prescription for Oxy. After 10 days, I was tired of sleeping so much, and tapered myself off it taking nothing more than Tylenol which was sufficient.  I had no issues coming off the drug. I’ve been told I have a non-addictive personality, which I am thankful for.  But can an insurance company test for that?  I sure needed the Oxy those first couple of weeks.

    • #72
  13. jef1944 Member
    jef1944
    @

    The problem with making one size fits all rules for drug distribution is that we are all so individualistic in how we react to any given medication. We are also quite different regarding our perception of pain. What I would call low level pain (2-3 on a scale of 10), would probably be a 6 to someone with a lower threshold of pain than I have.  Having endured two knee replacements (after many years of excruciating pain), I have a very high pain threshold, and a very low tolerance for enduring any more pain. These days I’m just striving for a livable level of comfort.  I refuse to worry about addiction, although I am surely dependent on opiates,it is an acceptable trade off for me.

    • #73
  14. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    jef1944 (View Comment):
    . I refuse to worry about addiction, although I am surely dependent on opiates,it is an acceptable trade off for me.

    That is definitely the question, though.  Is it?  There are some people who are dependent and are no longer functional members of society.  This isn’t due to disability, but due to medication.  The medication makes patients unwilling to participate.  At that point, it isn’t about pain relief, it is about something else.  When you would rather be sluggish or high than functional, it has moved from a medical issue to a recreational issue.

    Since we’re moving toward single payer, this will be judged more harshly.  Why should we pay for someone’s high?  Why should we pay for them to languish in unemployment and narcotics?

    It is one thing to be dependent on drugs, I most certainly am.  It is another to be in a taxpayer funded drug haze.

    • #74
  15. JLock Inactive
    JLock
    @CrazyHorse

    Steve in Richmond (View Comment):
    My main exposure to opiates was after hip replacement surgery. I had some minor complications requiring a 3 night hospital stay. The percocet they started me on was prescribed every four hours, but the pain came back after 3. When I mentioned this to the Dr. he changed the prescription to straight Oxycontin at a higher dosage. That worked great, until the 2nd night when the night nurse told me in no uncertain terms she did not agree with this dosage. And then she wouldn’t give it to me. Well, she didn’t tell me she wouldn’t give it to me. She just made me wait 6 hours instead of the 4 I was supposed to, even thought she gave me other medications on time. I felt no effects other than pain while waiting. On discharge, I was given a 3 week prescription for Oxy. After 10 days, I was tired of sleeping so much, and tapered myself off it taking nothing more than Tylenol which was sufficient. I had no issues coming off the drug. I’ve been told I have a non-addictive personality, which I am thankful for. But can an insurance company test for that? I sure needed the Oxy those first couple of weeks.

    A perfect example of how much personal vigilance factors into success rates — that both insurers and Pharma take credit for by incorporating into their data.

    • #75
  16. JLock Inactive
    JLock
    @CrazyHorse

    TheRightNurse (View Comment):

    Susie (View Comment):
    I feel your pain TheRightNurse, I now have to pay for my Midrin for migraines. It has an analgesic, vasoconstrictor and a light sedative. Thanks, Insurance Overlords.

    A sedative?! I bet it’s an opiate! Addicting and habit-forming, it clearly should be restricted! My god, are you okay? Are you sure you’re not already addicted? I bet they have some online coaching for that…

    This is why Nurses make excellent counselors — provided you are actually willing to do the work in getting better. And terrible therapists.  Less Bob Saget and more Bobby Knight.

    • #76
  17. valis Inactive
    valis
    @valis

    If you need controlled substances, try to find a street dealer.

    Doctors are being tracked by their state medical board.  No license, no work.

    DEA matters less than state.

    NC is working on a law tracking/limiting how much we prescribe.

    Don’t break anything or hurt too much, you might be out of luck.

    • #77
  18. Kozak Member
    Kozak
    @Kozak

    valis (View Comment):
    If you need controlled substances, try to find a street dealer.

    Doctors are being tracked by their state medical board. No license, no work.

    DEA matters less than state.

    NC is working on a law tracking/limiting how much we prescribe.

    Don’t break anything or hurt too much, you might be out of luck.

    I cannot tell you how glad I am that I’m nearing the end of my career. Seriously. Trying to get credentialed at a hospital to work makes you feel like you are major felon.

    • #78
  19. civil westman Inactive
    civil westman
    @user_646399

    Kozak (View Comment):

    valis (View Comment):
    If you need controlled substances, try to find a street dealer.

    Doctors are being tracked by their state medical board. No license, no work.

    DEA matters less than state.

    NC is working on a law tracking/limiting how much we prescribe.

    Don’t break anything or hurt too much, you might be out of luck.

    I cannot tell you how glad I am that I’m nearing the end of my career. Seriously. Trying to get credentialed at a hospital to work makes you feel like you are major felon.

    Exactly. It took a few days to get the ink off my fingers last time I was fingerprinted. I must now prove I am not a child molester every three years. Fingerprinting supposedly proves that to the state board of licensure.

    • #79
  20. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    civil westman (View Comment):
    Fingerprinting supposedly proves that to the state board of licensure.

    Because not getting caught is the same as not committing a crime.

    • #80
  21. Henry Castaigne Member
    Henry Castaigne
    @HenryCastaigne

    Randy Webster (View Comment):
    I asked the pharmacist how the insurance company could buy me drugs costing $213 for three months while only charging me $84. He didn’t really have an answer.

    That is the problem with everything.

    • #81
  22. TheRightNurse Member
    TheRightNurse
    @TheRightNurse

    Henry Castaigne (View Comment):
    That is the problem with everything.

    No, it really isn’t.  I’m more interesting in my pharmacists understanding drugs than the stupid policies that regulate drug prices.  We have specific people for that in the hospital because people who provide care cannot be expected to know the ins and outs of the insurance rules; there are far, far too many.

    • #82
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