Moral Turpitude

19 06 2018

The news media in this country has been wringing their hands lately about the latest crisis-du-jour– the mind-bogglingly large numbers of people growing addicted to (and not-infrequently dying from) misuse of opium-based analgesics. While this technically includes opium, heroin, and morphine, these are not the primary pharmaceuticals singled out for that special ‘hushed-voice’ description. The media is usually speaking of percocet, oxcontin, and oxycodone- different flavors of codeine-based chemicals mixed with different levels of acetominophen to improve the level of pain relief.

Lots of media personalities with furrowed brow have opined on this or that aspect of the “opiod epidemic”, with most of the blame falling on several dozen so-called “pill mills”, which exist solely to feed the raging black-market demand for these pharmaceuticals by issuing prescriptions for absurd amounts of the drugs for just about any complain. When the local cops and Federal agencies shut these pill mills down, they re-form with “new management” a few miles away (often in a different county) to start the process all over again.

One would think this sort of problem would be an auspicious use of Federal and State law-enforcement funding and training, and one would hope such organized crime were the subject of intensive effort by every level of law enforcement. Sadly, this is NOT the focus of Federal and State law enforcement. Apparently, going after organized gangs who dispense dangerous drugs as if they were a new form of candy is just too hard. So the focus is on Your Doctor.

Your doctor, my doctor, and most of the other physicians practicing in the US are not involved in organized crime, they keep diligent records, have a regular practice in a hospital and/or office, and rarely have high-priced mob attorneys on speed-dial. They’re also not even vaguely the biggest source of misused opiods, but they are easy to get at. So the Feds and State law enforcement troopies have been making their lives Hell.

And then the Puritan shitweasels get involved.

If the “opiod crisis” was merely some people getting too many pain-killers, it would be just a law-enforcement issue. It can’t be just a law-enforcement issue for Puritan Shitweasels- it also has to be evidence of moral failure. If the opiod epidemic was caused by moral failures, then Puritans could feel ever-so-smug and righteous and holier-than-thou about the people falling victim to these drugs. If opiod addiction is proof of a lack of morals, then the Puritan Shitweasels can wash their hands of any responsibility for providing treatment or assistance.

And that is how the issue has been re-imaged here in the US. Everyone who uses pain-killing drugs has something morally wrong with them.

Here in the Shallow South, for example, your doctor can no longer prescribe a wide variety of analgesics. All such prescriptions must be controlled by state-approved “pain management” programs.

Let us say you were a 80% disabled veteran living in the Shallow South. The disabling condition which got you your medical discharge has left you in constant pain for fifteen years. During those fifteen years, you have been diligently avoiding prescriptions of codeine-based drugs because they lend themselves so easily to addiction and further depress your mental acuity to ‘drooling moron’ for far longer than the pan-killing effect. You and your doctor have settled on a drug which is far more expensive, is hard to grow addicted to , and doesn’t have the severe mental depressant effects of most codeine-based drugs. You’ve been taking this drug and have remained largely a productive citizen for more than a decade as a result.

But then, your doctor informs you he cannot prescribe this drug anymore because of the “opiod crisis”, and you will have to see a pain-management center in order to get your pain-killer. You may be of the opinion this was dumb, and you probably have a lot of company in that opinion, but you get yourself duly assigned to yet another doctor who knows NOTHING about your medical history. And then the stupidityness starts in earnest.

– All prescriptions for pain medicines MUST be issued by the pain management doctor, or you risk getting thrown out of the pain-management program. Even if you get hit by a truck and the ER doc gives you some painkillers, you cannot fill that prescription. You MUST take it to the pain-management doc who will then decided if you get it or not.

– Your prescriptions must all be filled only at one pharmacy of your choice. If that pharmacy (say, Rite-Aid) can’t fill the prescription, but another Rite-Aid a few miles away can do so, you risk getting thrown out of the program for “pharmacy shopping”.

– You must see the pain-management doc every 90 days, without fail, regardless of holidays, national emergencies, your pain-management doc quitting the practice, or any time you may spend in the hospital. Failure to comply gets you thrown out of the program.

– You must bring your pain meds with you to every appointment so they can be counted by hand to determine if you’re misusing the drugs. You also have to give a urine sample at every appointment to make sure you don’t have anything else in your system.

– You are prohibited from consuming alcohol in any form while you are in the program.

Let us further imagine you- the 80% disabled veteran above- are scheduled for some surgery in a last-ditch attempt at removing or reducing the pain. Prior to surgery, you duly let your pain management doc know the surgery is coming up and you will require post-operative pain treatment. Your pain management doc will issue a prescription for what HE thinks you will need, not the doctor doing the surgery. Let us assume you spend two days in post-op while the hospital tries to get a handle on your pain (on a logarithmic scale, where 1 is a paper-cut, and ten is you begging the doctors to remove your limb), and the surgeon prescribes an additional pain med to use in conjunction with the opiods already prescribed. Well, now, you’re right proper fucked.

Trying to follow the byzantine set of rules for pain management, you call the pain management folks to tell them you have a new prescription in addition to the original one. You get transferred to the ‘prescription line’ which has been set up for re-fills only, and has no provisions for a new prescription. You get told they’ll get back to you in five business days. You make multiple calls to pain management, trying to break through to someone with a functioning brain. Finally, in despair, you grab your hospital discharge paperwork and the prescription from your surgeon and have your wife drive you down to the pain-management clinic just two days after discharge in order to explain in baby-talk to the clinic staff that you can’t really wait for five fucking days.

Finally, you’re back home in bed, with your wife at the local pharmacy getting your newly-approved meds, and the phone rings. It’s the pain-management clinic telling you they’ve decided NOT to approve your surgeon’s prescription.

Current status: Vexed

Current music: The System of Dr. Tarr and Professor Fether by Alan Parsons Project

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