By Cheree Cleghorn, Editor

The Associated Press has examined the use of painkillers in America—-there was an 88 percent increase between 1997 and 2005.

Doctors are having to work without any guidance about what’s appropriate. Unfair to them. Unfair to patients.

That increase is due, in part, to a noble purpose—-helping patients manage pain at tolerable or better levels.

The AP story says that for the last 30 years, doctors have considered pain management part of caring for patients. More aggressive pain management helps patients recover. Therefore, more prescriptions are being written.

The AP also says that part of the increase in use is due to changes in population. There are more older people. Older people tend to have more conditions which are painful.

The increase also is due to some bad reasons.

Excess demand may arise for a drug more powerful than a patient needs simply because the patient has seen it advertised.

The 88 percent jump also is due to drug abusers, users and dealers.

It’s easy to see why there is a war going on about pain medicine.

The war is between and among caregivers who are committed to intelligent pain management for patients and other doctors, who feel that doctors are too quick to pick up their pens to write an RX for one of the top five drugs of choice for pain. The story does not attempt to gauge how many doctors are for or against aggressive pain control.

State and federal officials have gone after doctors with raids and arrests—-enough high-profile activity to make any doctor wary about being targeted or losing their licenses.

You may be a casualty in this war when, for example, you have had surgery and need pain medication. When you have cancer and need relief. When you have had an injury.

You would think reasonable people could develop clinical guidelines to settle this matter.

They did.

Medical societies and other experts worked with the federal government for some two years to develop guidelines. These guidelines went up on the government’s website, only to come down shortly after posting and without warning. Why? There was no explanation given.

Doctors are having to work without any guidance about what’s appropriate. Unfair to them. Unfair to patients.

Try getting a prescription filled for Oxycontin just once. It all depends on where you live what the reaction will be.

In 2006, in Washington, D.C., the friend of a surgical patient called their pharmacy—-where the patient and friend were both well-known to the staff—- to ask about how long it would take to get an Oxycontin RX filled. The on-duty pharmacist said, “We don’t discuss this!” and slammed the phone down.

The friend then set forth, prescription in hand, doctor’s pager number in hand and with proof of the patient’s identification, in search of a drugstore which would fill this much-needed prescription.

A drug store, long one that others count on for back up for rarely prescribed medicines (including in the early days, AIDS drugs), said the store no longer stocked Oxycontin.

There have been break-ins, the pharmacist said, at his store and in stores all over the country. These robbers aim is to snatch pain-killers which have high street value.

Finally, the friend decided to hit the suburbs.

That worked.

But they, too, were extremely cautious. They asked questions about the doctor. Where did he work? What was that pager number? It appeared that they called him. However, in the end, they did provide the medication.

The patient’s doctor gave her no heads-up about how hard it could be to get these pills. He should have.

From start to finish, it took five hours to get this medication filled for a legitimate need.

When we all are regarded as suspects, something is terribly wrong with the system.

Some pain management experts, the AP story says, are becoming apprehensive about writing prescriptions even for their sickest patients because of those high-profile arrests and prosecutions by state and federal officials.

What Can You Do?

First, if you are about to have surgery, ask the doctor for the RX in advance and the name of a pharmacy which will fill it. If the doctor is on staff at a hospital which has a pharmacy open to the public, that hospital pharmacy may be the best place. They know the doctor.

Second, if you have a chronic, painful condition, talk to your doctor about how the two of you can work together to manage your pain. When pain management experts are apprehensive about writing prescriptions, you need a strategy for controlling pain that the doctor can agree to and that you can manage.

Third, if you, or a friend or family member, has a life-threatening or terminal illness,
do the same. Find out, before the patient is writhing in pain, what the doctor’s approach to pain management is.

If you are uncertain that the doctor is committed to keeping the patient out of pain in a way that meets specialty clinical guidelines (which are not the same as federal guidelines), start looking elsewhere for a doctor. The doctor may fear losing a license, being arrested, facing penalties—-being treated as a criminal. You can not blame the doctor in this environment.

Academic medical centers are good places to look at times like these. The fact that everyone is looking over everyone else’s medical shoulder should make officials more comfortable with faculties’ use of controlled substances like Oxycontin. Nothing is certain, however.

Do not appear to be shopping for a doctor specifically for the purpose of getting pain medications.

You’re not.

You are looking for proper management of a condition or problem, and one part of proper care is pain control.

Acupuncture and other complementary and alternative medicine approaches can reduce pain. You will want to know more about those, too.