Paralysis by Urinalysis

doctor-with-urine-sample-via-shutterstock-615x345Paralysis by Urinalysis

If I fail a urine screen I am then discharged from treatment by my doctor.  This has become an all-too-common practice at many .. practices. Isn’t this ridiculous?  I mean, hypothetically, if I decided to go to an all night 70’s disco cocaine party and decided to partake (hypothetically) then I am in danger of losing the services of my orthopedic surgeon who is helping to mend my back after a near-paralyzing car accident?  Ridiculous.  A joint to help me sleep?  Say goodbye to my recovery from spinal injury.  Is there even a justification for this?  I will play devil’s advocate and try to defend the indefensible here.  Note:  Any position that isn’t mine is indefensible.

We can’t be providing opioid medications to patients who are themselves drug users.  There could be dangerous interactions and other irresponsible behavior that would cause them to harm themselves.  They would need a doctor.  They should be discharged from my (doctor) practice.

We have to test their urine frequently to be sure that we are not contributing to a patient’s drug problem or addiction issue for which they should be seeking professional help.  They would definitely need to see a doctor if they had an addiction problem.  These patients definitely should be discharged from my (doctor) practice.

By testing our patients’ urine, we can see who is a complicated patient so we can quickly discharge them from our practice, thus leaving us with the simple patients who quietly come and go, pay their bill on time, and allow us to pack in more patients (more money!)  Complicated patients take up too much time and cost us too much money (not to mention effort).  Money and effort should never be expended needlessly in our line of work.  Just tell them we can lose our license (an incredible irony when you consider that by KEEPING them as patients and TREATING their destructive tendencies by way of referrals or their addiction we would be acting MORE like doctors and thus be MORE worthy of our licenses) and keep having them make the walk of shame from bathroom to waiting room holding their leaking urine vials.  I became a doctor to get rich not to treat people who have unhealthy habits or dangerous behaviors.  Those people should go get their heads examined.  …by a doctor, I guess.  I’m confused.

Doing drugs is unhealthy although often a lot of fun.  If you choose to do something this stupid (awesome) then you should not be in danger of losing the services of a competent medical professional.  It should be noted, however, that if your doctor discharges you for failing a urinalysis, subjecting you to both withdrawal and the care that you deserve due to an injury or illness, the maybe your medical professional isn’t so competent after all…

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The Horror of Incredible Pleasure

Poison purposefully positioned to push me up that aching ladder once again.  The world is different when you’ve got the key to heaven’s door. Never then again does life and its undulating grey ever smile the same.  It’s more than “hi”, it’s true love.  This time, a broken heart comes with crushing flu and a violent exit of all guts and those that lie therein.

The fun “oops” comes when, in heaven, you suddenly get bored.  From there, kids, there is no ladder, only a violent plunge into hell and a prayer that you will soon resurface on Earth.  Praying in Heaven.  Bored in Heaven.  This is the Horror of Incredible Pleasure.  Join me…

Why do I keep getting high and hit the ground every time?

If I go up into the sky how is there a bottom?

All of logic this defies I’ll never stop

This is the horror of Incredible Pleasure

This is the horror of Incredible Pleasure

Don’t name me for my head call master of the living dead…

I’ll Support A Cure For AIDS When You Support A Cure For Substance Abuse

Like most educated people, I know that equal isn’t always fair and to be fair is not always to be equal. So, with that in mind, I give voice to a growing concern I have and ask that you consider it before making an easy snap judgment.

AIDS is a terrible affliction. It is brutal and unfair. We should and do dedicate money and resources to bring about its annihilation. One who contracts HIV and, consequently, the AIDS virus is seen as a victim and is comforted by the support that is readily available to them. Fair. I am proud of this part of our culture.

Digging deeper I ask, “How does one contract this terrible disease?”. The most common ways you can catch HIV/AIDS are, to quote Wiki:

The most common way is thru sexual intercourse (oral, anal, and vaginal) however, u can catch it by intravenous drug use, blood transfusions, open wounds (anywhere where fluids can be exchanged)

So, we see that the top two ways of catching the disease are: 1) Unprotected sex & 2) Intravenous drug use. Hold that thought and keep in mind the empathy and support gushed upon AIDS patients.

Drug Addiction. ::crowd goes oooooh:: Dead rock stars, actors, and junkies. They had it coming and deserved it. They should have stopped using or never started. They made bad decisions and brought sickness upon themselves. I believe that this is a fair summation of the prevailing attitude towards drug users. Unlike HIV/AIDS there is no empathy, sympathy, or support for the disease of drug addiction. Yes kids, it is a disease. No addict enjoys using. This is the nature of addiction. It is a sickness acquired by either bad decisions or emotional problems such as Depression that do not respond to pharmaceuticals. Once addicted, the individual goes from mentally craving the “high” to physically needing the drug for basic sustenance.

The most common causes of drug addiction are: 1) Depression & 2) Substance Abuse

So, because of either a bad decision, or an untreated mental illness, an individual can become a drug addict.

Recently I watched the 79th All-Star Game at Yankee Stadium and heard the commentators tell and retell the story of how Josh Hamilton overcame drug addiction to reclaim his place in Major League Baseball. Every time, however, they clearly stated that Hamilton had missed three years of baseball and had almost died because of a sickness he “brought upon himself” or a lifestyle he “chose to live”. Is that so? Do you think that Hamilton wanted it this way? We’ll leave that as a rhetorical question as I ask a more poignant question. What if we prefaced those afflicted with AIDS the same way?

“He was an excellent student and had a bright future until he contracted HIV, a sickness he ‘brought on himself’.”

“There is a terrible AIDS epidemic in the inner city. Apparently this is a lifestyle more people ‘choose to live in South Chicago’.”

Never would you hear this because somewhere, sometime it was decided that using dirty needles and having unprotected sex was a sickness worthy of our deepest sympathies and deepest pockets. Similarly, it was decided that those trying to alleviate the terror of Depression or choosing to experiment with drugs almost deserved to become afflicted with Drug Addiction. There is no sympathy for Drug Addicts and this is because there is little understanding of the disease. Further, there is an incorrect stereotype and image of the “typical” drug addict that makes it impossible to garner support for these sick people. Thus, this sickness feeds on itself. Without a clear support channel, addicts often want to heal and overcome their affliction, but professionals from doctors to pharmacists make any help given magnanimous at best. The addict then relapses and falls deeper into despair knowing that the world is essentially against them and this monster that rules their existence is never going to be put down unless they tread this terror-laden road completely alone.

Josh Hamilton overcame his drug addiction. Why? Because he had, and still has, a companion who stands by his side and supports him. This prevents him from relapsing. To wit; Hamilton said, “Without his support I would never have gotten clean. I still need his help daily. I still don’t trust myself.” Seems that Hamilton is a pretty lucky guy. Most people are repulsed by drug addicts while they wear ribbons and hold fundraisers for AIDS victims. Remember the bulk of those falling victim to either affliction did so because of bad luck and/or poor decisions. Why do we then embrace those with AIDS and shun those with a drug addiction? It is a more pertinent question then you may believe, especially when you take in to account the story of Josh Hamilton and the success that he attributes to the intangible support of a beloved friend.

I asked before that you reserve judgment here and consider the case I am making. I know that I am being a bit hyperbolic with some of the argument, but you have to agree that it is worth some thought. Certainly I am not diminishing the tragedy of AIDS. I am only using it to shed light on the issue of drug addiction and the equal need for support with this disease.

If we continue to shun addicts and avoid the problem, it will get worse and many people will die. Now that we have the gateway drugs of Vicodin and Oxycontin being liberally prescribed by “health” professionals. Do you know that the makers of these drugs were found guilty of many high crimes recently for misrepresenting how addictive their “medicine” is. The result? They paid a stiff fine and the drugs remain on the market. Hmmmmm… Take a look at how many teens are dying from prescription medication. Then take a look at how many heroin addicts were led to this affliction by an opioid medication dispensed by their trusted doctor and local pharmacy. This is another issue and I am on a tangent, but it does deserve a mention here.

I ask that we begin changing our view of a drug addict and finding ways to support their desire to become clean. Like an AIDS victim, we must see drug addicts as sick people in need of care. If we do make this paradigm shift, we will stop this sickness before it inevitably becomes an epidemic and takes away the lives and contributions of more wonderful people. Everyone deserves another chance, despite the mistakes they have made. Nobody deserves to contract AIDS or a drug addiction. Both can be stopped with proper education and support. Let’s try harder to be fair…

Oh Oxycontin, You Make Me Feel So Itchy

I wonder many times about the ill effects of each and every illicit drug sold on street corners and internet sites.  Then I wonder the same about the ones that are prescribed to us.  I have a story I would like to share and I hope that it will inspire some of you to comment and share some similar experiences.  I won’t even lie, this story is about me, not some “friend” or nameless individual.

In 2001 I was riding home with my (then) girlfriend from a nice dinner in a waterfront town.  We obediently stopped at a bright red traffic light.  Then we saw bright lights behind us.  Those lights belonged to a drunk driver in an SUV who was, apparently, not so obedient towards the red light.

He collided full speed into us (who were at a dead stop – no pun)  the little Mistubishi was a mass of junk metal.  My mouth wasn’t working.  I was taken to the ER and they fixed my jaw which had been badly busted in the accident.  They referred me to an Oral Surgeon.

I went to the OS and he was super-de-duper-nice.  He examined me, prescribed physical therapy and gave me Endocet, a generic form of the celebrity Percocet.  The drugs eased my pain and I began to look forward to taking them each night.  Each morning.  At lunch.  Then when I was bored.  Needless to say, my “pain relief” got a bit out of hand.  I told the doctor what was happening and he said that, although they were addictive, if you wanted to stop, you’d feel like crap for a dy or so, then be back to tip-top shape in no time.  I was pleased.  He handed me another script.

And so it went until 2005.  This was the year that I became a strong believer in angels.  I was, again, passenger in a car headed down to South Jersey so we could help a friend move.  I was reading a magazine, then looked up to see a van with its hazards on STOPPED in the left lane of the NJ Turnpike.  What happened next I don’t know.  All I know is that I awoke in a furry haze of giddy numbness to a throng on onlookers asking “Is he dead?”  Soon I realized they meant me.  I was wrapped in metal and covered in blood.  A super Paramedic with a very concerned look on his face was stabilizing my head and trying to keep me from dying.  I haven’t told my family this, but I was resuscitated at the scene because I had no heartbeat.  I was dead for a bit.  Wild.

I came to and began a long rehabilitation process which involved consistent pain management.  the pain management clinic gave me more Percocet – the strongest one available.  I had to take it to stop the pain and be functional, after my teeth were all reconstructed – they were shattered in the accident.

Now comes the critical mass of where medicine can force and addiction on a patient and cause more harm than good.  I couldn’t go a day without my pills and if I ever ran out, Hell engulfed my body and ripped me to shreds from withdrawal.  Some catch-22, huh?  If I take the pills, I’ll feel fine but be a junkie.  If I don’t I’ll be a throbbing mess of pain and healing bones, herniated discs, etc.  I wouldn’t be able to live any semblance of a normal life.  Addiction was part of my treatment.

And such is the way of modern Pain Management.  I don’t question their integrity, but their tools are far too limited.  Percocet works great, but do you think we could take out the “strung-out-on-heroin” part?  I am a fan of technology and know that Lexus just released a car for idiots who can’t park for themselves.  It will parallel park for you.  If we can do that, can we work on a drug that won’t turn me from victim to junkie?

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