Change always occurs in pendulum swings. The medical community has gone from paying too little attention in prescribing pain medications to being paranoid about prescribing them. Rather than subjective patient pain levels dictating decision making, concern over D.E.A. investigations are now the primary influence.
This leaves us with an important problem – how do we determine who is “drug seeking” and who’s reporting valid pain?
Fortunately the U.S. Department of Justice Drug Enforcement Administration Office of Diversion Control offers the Common Characteristics of the Drug Abuser:
Unusual behavior in the waiting room;
Assertive personality, often demanding immediate action;
Unusual appearance – extremes of either slovenliness or being over-dressed;
May show unusual knowledge of controlled substances and/or gives medical history with textbook symptoms OR gives evasive or vague answers to questions regarding medical history;
Reluctant or unwilling to provide reference information. Usually has no regular doctor and often no health insurance;
Will often request a specific controlled drug and is reluctant to try a different drug;
Generally has no interest in diagnosis – fails to keep appointments for further diagnostic tests or refuses to see another practitioner for consultation;
May exaggerate medical problems and/or simulate symptoms;
May exhibit mood disturbances, suicidal thoughts, lack of impulse control, thought disorders, and/or sexual dysfunction;
Cutaneous signs of drug abuse – skin tracks and related scars on the neck, axilla, forearm, wrist, foot and ankle. Such marks are usually multiple, hyper-pigmented and linear. New lesions may be inflamed. Shows signs of “pop” scars from subcutaneous injections.
Now, for all that the D.E.A may be on top of, one thing is certain: grammar is not their specialty. I cut and pasted the bizarre number of semicolons directly from their site.
Given the D.E.A’s antiquated and stereotypical findings, how are we to convey our needs to prescribing physicians and clinicians without creating the appearance of drug seeking?
Jim’s Corresponding Do’s and Don’t’s for Reporting Pain & Ensuring DEA compliance:
· Ok – nobody knows for sure what “unusual behavior” is so everybody be cool and ACT NORMAL! (while experiencing high levels of pain)
· It seems assertiveness is bad. Please stop advocating for yourself immediately. My wife can never talk to a doctor again.
· Ok – let’s not look bad when we’re in excruciating pain and don’t go showing up at the ER wearing your Sunday best.
· Stop reading WebMD immediately. You might learn too much about your health conditions and appear sketchy
· Ok – bad news: being poor and not having a PCP or health insurance just became suspicious.(Wow, really?)
· If you have a chronic pain condition – something really scandalous like being an above the knee amputee, don’t explain that you know which meds work for you and which do not. It’s important that the doctor do trial and error each time.
· Feign interest in the medical terminology your doctor lodges at you. Don’t just take the discharge papers home and call the medical professional you’re distantly related to from home. Hang on every word your doctor rapidly spews as though it’s fascinating.
· No exaggerating! Describe your high pain levels in um, reasonable ways…
· Mood disturbances are bad – no mood swings as you sit in the ER for 4-6 hours. If you’re feeling suicidal, don’t tell anyone. If you’re having sexual dysfunction get online and order meds like everyone else.
· Ok. I concede the final point. If you’re showing up with track marks; it’s beyond time to get help.
Just when I thought we were educating people on how to advocate and communicate with the medical professionals in their lives, the D.E.A. ensures that we get judged by appearances and other highly subjective observations.
Any seasoned ER doctor could write a better list than what appears on the D.E.A site. Any experienced addictions counselor could write on the subject. Best of all, any Recovering addict could spot someone med seeking in under 30 seconds.
I renew my assertion that the REAL experts on drug abuse are people with long term recovery from addiction. I thank the D.E.A. for a laugh at their absurdity and I pray for my friends and family who live with chronic pain conditions. We have a lot of work ahead.