Good Sam Follows Bad Policy
Good Samaritan makes a Bad Policy decision in forcing Patients to choose between Opiates and Cannabis.
In essence, Good(?) Sam is Punishing Patients for being cured with Cannabis.
And Why? Was somebody harmed by concurrent use? Did they end up overdosing on Opiates or other negative consequnces?
No, in fact opiate use is typically decreased when used in conjunction with cannabis.
So what's the problem? Well, as one of my elders once told me, when it don't make sense, follow the money.
Thus We can imagine that who ever is getting paid for the opiate use is Not Happy about any decrease in use.
We just hope that this isn't a case of Good Sam or the Doctors having stock in the Opiate company, or something like that.
In addition, the specter of Politics raises it's ugly head.
Has the DEA come thru and told Good Sam to do this or all of it's Doctors Controlled Substance licenses will suddenly need to be re-inspected?
Policy means Many Medical Cannabis Patients Experience Discrimination From Their Physicians
Cannabis activists, particularly those that have worked in medical cannabis clinics, have heard more and more stories regarding patients experiencing severe discrimination from their physicians due to their use of medical marijuana, even when allowed under state law. Published stories regarding patients being denied transplants have surfaced, and even some signs of hope that such a policy, with no scientific basis, is starting to be reformed.
Many patients are now reporting that they are being forced to choose between medical marijuana and pain medication, with doctors threatening to stop prescribing pharmaceutical pain killers if the patients continue using medical cannabis. Many patients anecdotally have reported using fewer pain killers such as OxyContin due to using medical cannabis. Scientific research now backs up these anecdotal claims.
Pain Patients, Pain Contracts, and the War on Drugs
Pain contracts. Pain management contracts. Medication contracts. Opioid contracts. Pain agreements. They go by different names, but they all mean the same thing: A signed agreement between doctor and patient that lays out the conditions under which the patient will be prescribed opioid pain medications for the relief of chronic pain. (To see a standard pain contract, see below )
For some of the tens of millions of Americans suffering from chronic pain, opioid pain medications, such as Oxycontin or methadone, provide the only relief from a life of agony and disability. But with the Office of National Drug Control Policy's ongoing campaign against prescription drug abuse and the Drug Enforcement Administration's (DEA) ongoing crackdown on physicians it believes are prescribing opiates outside the bounds of accepted medical practice, the medical establishment is increasingly wary of pain patients and adequate treatment of pain is a very real issue for countless Americans.
In recent years, doctors and hospitals have turned increasingly to pain contracts as a means of negotiating the clashing imperatives of pain treatment and law enforcement. Such contracts typically include provisions requiring patients to promise to take the drugs only as directed, not seek early refills or replacements for lost or stolen drugs, not to use illegal drugs, and to agree to drug testing. And as the contract linked to above puts it, "I understand that this provider may stop prescribing the medications listed if... my behavior is inconsistent with the responsibilities outlined above, which may also result in being prevented from receiving further care from this clinic."
"Pain agreements are part of what we call informed consent," said Northern Virginia pain management and addiction treatment specialist Dr. Howard Heit. "They establish before I write the first prescription what I will do for you and what your responsibilities are as a patient. They are an agreement in order to start a successful relationship that defines the mutual responsibilities of both parties. More and more states are suggesting we use agreements as part of the treatment plan with scheduled medications. Such agreements are not punitive; they protect both sides in functional way."
If Heit sees a cooperative arrangement, others disagree. "This is really an indication of how the current DEA enforcement regime has created an adversarial relationship between patients and physicians where the doctors feel the need to resort to contracts instead of working cooperatively with patients," said Kathryn Serkes, spokesperson for the Association of American Physicians and Surgeons (AAPS), which has been a fierce critic of criminalizing doctors over their prescribing practices.
"The pain contracts are a tool to protect physicians from prosecution. He can say 'I treated in good faith, here's the contract the patient signed, and he violated it.' It's too bad we live in such a dangerous environment for physicians that they feel compelled to resort to that," she told the Chronicle. "Patients aren't asked to sign contracts to get treatment for other medical conditions," Serkes noted. "We don't do cancer contracts. It is a really unfortunate situation, but it is understandable. While I am sympathetic to the patients, I can see both sides on this," she said.
"There is no evidence these pain contracts do any good for any patients," said Dr. Frank Fisher, a California physician once charged with murder for prescribing opioid pain medications. He was completely exonerated after years of legal skirmishing over the progressively less and less serious charges to which prosecutors had been forced to downgrade their case. "The reason doctors are using them is to protect themselves from regulatory authorities, and now it's become a convention to do it.
They will say it is a sort of informed consent document, but that's essentially a lie. They are an artifact of an overzealous regulatory system," he told the Chronicle. "When this first started, it was doctors using them with problem patients, but now more and more doctors and hospitals are doing it routinely," Fisher added. "But the idea that patients should have to sign a contract like that or submit to forced drug testing is an abrogation of medical ethics. Nothing in the relationship allows for coercion, and that is really what this is."
The pain contracts may not even protect doctors, Fisher noted. "When they prosecute doctors, they can use the pain contract to show that he didn't comply with this or that provision, like throwing out patients who were out of compliance. The whole thing is a mess."
Q: DEA has a Medical license so NO pain patients are allowed opiate medications? ER doc refuses to even examine or evaluate pain due to history of chronic pain.
I tried to explain that this is new acute pain and was handed a printed message stating that their hospital would not give injections or oral narcotics to pain patients due to DEA pressure.
This has been going on for months now, I have been told by some physicians that I truely need pain medications, but they don't write scripts for those due to their clinics directives from DEA. I can barely walk due to pain and have been to previous pain clinic and told to go to pool therapy..that is now finished. Pain is still increasing. Went to new Pain Program and was told I needed eval by their PT, psychologist, neurologist, MRI of lumbar spine and pelvis x-ray, and releases signed for medical history. PT at pain clinic told me they could only partly help me as my scans and lab tests show significant painful conditions. I am still waiting for a decision by the pain clinic if they will agree to treat me.
I was told if I got all these screenings done he would see me as soon as possible as it was obvious I was in a lot of pain. I called his nurse AGAIN today and was told that next opening to see doctor was April 5th-2 months from now still! Then I was told he could possibly fit me in sooner, my information was on his desk, but he will not be back in that office until next week.
My GP angrily told me that opiates were only for dying patients. I feel so guilty and weak and ashamed by all these reactions to my request for a modest amount of medicine to help me tolerate the pain. Don't tell me to find another doctor unless you know someone who will prescribe to a new patient! No one does in this area, I can't even get an exam!
Maybe I should try to find one of the "lonely street drug dealers" that the DEA has told us about through ADS on TV saying everyone gets high on prescriptions for narcotics from doctors, so Dealers don't have any business. Maybe they should advertise on TV so someone decides my need for medication besides the DEA! Has anyone else seen these "public service announcements"? I would go and get drunk but I went through the self-medication phase and have chosen sobriety for a year and a half so my mind would remain clear, I have no history of problems following prescription medication.
My mind is not clear due to severe pain. I became an RN because I respected the medical profession and wanted to be a part of it. Now if I want to practice medicine I have to work for DEA or an Insurance
Increased Access To Therapeutic Cannabis Likely To Reduce Patients' Use Of Opiates, Other Addictive Drugs
Regulating cannabis access would provide patients with an effective treatment for chronic pain and likely reduce morbidity associated with the use of prescription opiates and other pharmaceuticals, according to a review published in the Journal of Psychoactive Drugs. A researcher with the Centre for Addictions Research of British Columbia reports that cannabis may be useful in the treatment of chronic pain as well as certain substance abuse disorders, and that it poses fewer risks to health than many conventional alternatives.
He writes: "When used in conjunction with opiates, cannabinoids lead to a greater cumulative relief of pain, resulting in a reduction in the use of opiates (and associated side-effects) by patients in a clinical setting. Additionally, cannabinoids can prevent the development of tolerance to and withdrawal from opiates, and can even rekindle opiate analgesia after a prior dosage has become ineffective. Novel research suggests that cannabis may be useful in the treatment of problematic substance use. These findings suggest that increasing safe access to medical cannabis may reduce the personal and social harms associated with addiction, particularly in relation to the growing problematic use of pharmaceutical opiates."
The author continues: "Since both the potential harms of pharmaceutical opiates and the relative safety of cannabis are well established, research on substitution effect suggests that cannabis may be effective in reducing the use and dependence of other substances of abuse such as illicit opiates, stimulants and alcohol.
As such, there is reason to believe that a strategy aiming to maximize the therapeutic potential benefits of both cannabis and pharmaceutical cannabinoids by expanding their availability and use could potentially lead to a reduction in the prescription use of opiates, as well as other potentially dangerous pharmaceutical analgesics, licit and illicit substances, and thus a reduction in associated harms."
For more on this Action item, Contact organizer
Ed Julia Glick via FaceBook: Corvallis Cannabis Support Group - www.facebook.com/corvalliscanabisgroup, phone: 541-224-4039 -or- email: firstname.lastname@example.org *
more to The Story
Marijuana patients picket Good Sam
- by Bennett Hall, Corvallis Gazette-Times
Protesters claim Samaritan doctors won’t help them, but VP denies claim
See more >> mercycenters.org/tv/Events/
A handful of demonstrators gathered near Good Samaritan Regional Medical Center on Wednesday afternoon to protest what they claim is unfair treatment of medical marijuana patients by the hospital’s parent company, Samaritan Health Services.
Samaritan officials deny the claim.
Mamie Hobbs of Albany was one of eight people who positioned themselves on a grassy median near the entrance to the medical complex at Northwest Elks Drive and Highway 99W.
Sitting in a wheelchair and carrying a sign that read “Put Patients First,” Hobbs said she uses marijuana to treat chronic pain from arthritis and injuries suffered in a car wreck but has to go around her Samaritan physician to get the necessary medical recommendation.
“My doctor doesn’t discuss marijuana with me. He’s not comfortable prescribing it,” she said. “So I had to go out and find another doctor that prescribes it for me.”
Samaritan Health Services is the largest health care provider in the mid-valley, with five hospitals and dozens of clinics in Benton, Linn and Lincoln counties.
Ed Glick, a former Samaritan Health nurse who organized the protest, said experiences like Hobbs’ are typical of Samaritan patients who want to use cannabis for medical purposes as allowed under Oregon law.
“All I want is for Samaritan Health Services to start recognizing cannabis patients,” Glick said. “They’re treated like outcasts when they’re not part of the problem, they’re part of the answer.”
Julie Manning, Samaritan’s executive vice president for marketing and development, said the company does not tell its physicians how to treat their patients and has no policy against medicinal marijuana, either written or unwritten.
“We don’t have a policy,” insisted Manning. “Ultimately, what it really comes down to is how the individual prescriber and their patient decide to treat a particular condition.”
Glick and other protesters also object to what they say is an alarming new trend: Doctors forcing Oregon Medical Marijuana Program cardholders being treated for chronic pain to choose between cannabis and painkillers, even when patients who use weed are able to reduce the amount of opiates they take.
That’s a trend that goes far beyond Samaritan Health Services, according to Randy Day, the compliance officer for the Oregon Medical Board.
“The standard of care is shifting,” Day said. “More and more doctors are telling their patients it’s got to be one or the other.”
The winter edition of the board’s newsletter featured an article titled “The Pendulum of Chronic Opioid Therapy” by Dr. Barry Egener, the medical director of the Foundation for Medical Excellence.
Egener argued that the recent practice of liberally prescribing opiates for pain has gone too far and needs to be revisited. He specifically advised against the combination of marijuana and painkillers, despite the rise in state laws allowing recreational and medical use of cannabis.
“Patients should choose between marijuana and opioids,” Egener wrote, “and I’m always surprised how many opt for the former.”
Glick, who has written a response on behalf of the American Cannabis Nurses Association, calls Egener’s advice wrongheaded and counterproductive.
Using marijuana, he insists, allows many chronic pain patients to reduce their dependence on opioids, which can be addictive and have harmful side effects. They should not be forced to choose one or the other.
“It doesn’t make any sense, and it’s utterly cruel,” he said. “It’s putting patients in an awful vise.”
Glick worked for Samaritan Health Services for 15 years before being fired in 2006 when he refused to take a drug test. He says he was dismissed in retaliation for his outspoken advocacy for medical marijuana, a claim Samaritan denies.
For more on this story Contact reporter Bennett Hall at email@example.com -or- 541-758-9529 -or- click
>> here <<
More News and Info on the Issue:
ACNA Position Statement on Concurrent Cannabis and Opiate Use - Concurrent_Cannabis_and_Opiate_Use.html
Feature: Pain Patients, Pain Contracts, and the War on Drugs - by Phillip Smith, October 12, 2006 -
DEA has a Medical license so NO pain patients are allowed -
Freedom of Medicine and Diet: May 2008 | ... patients who need marijuana must choose between inadequate ... a health policy decision, ... was first seen as good before being seen as bad, ... Freedom of Medicine and Diet Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now- Thomas Jefferson Saturday, May 31, 2008 1988 DEA Administrative Judge Young Here's What Professional Liars Such As John McCain Ignore ( http://www.drugtext.org/library/articles/901405.html )
Rescheduling of marijuana Issues related to pending DEA ruling By Rick Doblin Master of Public Policy Candidate at the John F. Kennedy School of Government, Cambridge, Massachusetts Overview In September 1388, after two years of hearings, DEA Chief Administrative Law Judge Francis L. Young, Jr. recommended to DEA Administrator John Lawn that marijuana be reclassified into Schedule 2 of the Controlled Substances Act (CSA), to permit its use by physicians in the treatment of life- and sense-threatening diseases (1). Currently, patients who need marijuana must choose between inadequate treatment and buying black market drugs. Synthetic THC - Marinol. the major active molecule in marijuana, is in Schedule 2, as are cocaine, morphine and methadone. Marijuana in its natural form remains, with heroin, in Schedule 1.
The Weed Blog - Oregon Medical Board’s Medical Marijuana Policy > Many Medical Cannabis Patients Experience Discrimination From Their Physicians - http://www.theweedblog.com/oregon-medical-boards-medical-marijuana-policy/
MedHelp - C/T from opiates with marijuana - Addiction: Substance Abuse ... | It makes me happy that another person decided to choose ... marijuana, opiates and others ... this Site does not create a doctor / patient ... I'm on day 3 of quitting a 75 to 150 mg of oxy habit. Ive been smoking abou 3 grams of marijuana a day, my wd symptons dont seem that bad. I have had no diarhea (diarrhea) and no restless legs. Is there a connection. My opiate addiction has been going on for about 4 years.
... Many on here will not agree with the smokie smokie as a detox aid because it is not currently legal BUT for me and many others, it really took the edge off of withdrawal. I do not use it anymore and only used it for the first month or so but it really helped. I do not think it does anything for the actual brain part since they work differently from each other but I think it helps distract the brain from dwelling on the constant pain, depression, and anxiety that is usually associated with early withdrawal.
... As for you light symptoms, congrats! This should be a sign that this should be the last time! Oxy is one of the harder drugs to detox off of so count your lucky stars that you are not completely paralyzed by withdrawal. http://www.medhelp.org/posts/Addiction-Substance-Abuse/C-T-from-opiates-with-marijuana/show/1681820
Increased Access To Therapeutic Cannabis Likely To Reduce Patients' Use Of Opiates, Other Addictive Drugs - http://norml.org/news/2012/08/02/increased-access-to-therapeutic-cannabis-likely-to-reduce-patients-use-of-opiates-other-addictive-drugs
Cannabis entourage effect « WEST COAST LEAF | Today medical patients are often forced to choose between opiates and cannabis ... Many doctors who favor patient access to marijuana seem to have an insight into the entourage effects, while other doctors often see the patient’s attempts at access to the whole plant as merely ‘drug-seeking’ behavior. Doctors of 100 years ago hadn’t yet discovered THC, nor did they know that cannabis operated a separate receptor system from that of opiates. They did understand that cannabis taken with opiates was more effective than opiates alone, and they also knew that a patient with stomach problems could tolerate the cannabis better than the opiates. Today medical patients are often forced to choose between opiates and cannabis, even though they are shown to work together symbiotically. http://www.westcoastleaf.com/?p=3711
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