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Post by 100poppies on Mar 20, 2019 7:20:31 GMT -6
cakewench, maybe I’m assuming, but changing the guidelines for prescribing for acute pain shouldn’t affect chronic pain prescriptions. She’s just saying that for something like dental work or surgery, 7 days should do it. I assume at the end of that you could go back and be evaluated it more is necessary. People really are getting a months supply for wisdom teeth and other minor surgeries.
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richard
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Post by richard on Mar 20, 2019 7:23:24 GMT -6
I guess I'm only surprised it's taken this long for the whole George Conway thing to get to DJT's twitter timeline.
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Post by coconutbacon on Mar 20, 2019 7:32:14 GMT -6
Gillibrand has introduced a bill to limit opioid prescriptions to seven days for "acute" pain: Twitter seems very upset. I get the reasoning behind it, but for chronic pain sufferers, wouldn't something like this be pretty terrible? (Genuinely asking, I am not a medical professional and have only been prescribed opioids once or twice for very limited things.) I don't know. I am certainly not a medical professional, but I think there has to be better pain management options than longterm opioid prescriptions for chronic pain sufferers, including physical therapy, surgery and also alternative medicine treatments like acupuncture. I'm looking at this through the lens of someone who had a family member with severe, chronic pain have to go through a rehab program because she became addicted to the opioids she was prescribed. (But not before severe mental health consequences, including a suicide attempt.) But I'm sure that, $$$, insurance, etc is an issue here as well.
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dc2london
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Post by dc2london on Mar 20, 2019 7:42:49 GMT -6
cakewench, I would think chronic pain sufferers wouldn't be affected (in theory) bc the bill specifies acute pain. But I don't think those living with chronic pain are out of line for being alarmed, at all
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dc2london
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Post by dc2london on Mar 20, 2019 7:44:29 GMT -6
There's a fascinating discussion on C-SPAN right now with the coauthor of How Democracies Die.
He actually said that he regrets the recent DNC move to eliminate Superdelegates because, as he put it, party leadership know the candidates better than the people and can prevent the rise of a demagogue. He argued that Superdelegates would have prevented Trump.
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richard
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Post by richard on Mar 20, 2019 7:56:20 GMT -6
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jkjacq
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Post by jkjacq on Mar 20, 2019 7:57:50 GMT -6
AmyG, I'm so sorry and I hope things start to look up soon for you and H.
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jkjacq
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Post by jkjacq on Mar 20, 2019 8:12:40 GMT -6
cakewench , maybe I’m assuming, but changing the guidelines for prescribing for acute pain shouldn’t affect chronic pain prescriptions. She’s just saying that for something like dental work or surgery, 7 days should do it. I assume at the end of that you could go back and be evaluated it more is necessary. People really are getting a months supply for wisdom teeth and other minor surgeries. With chronic pain its fairly monitored in my experience.
My dad at one point had to meet with the Pain Clinic once every 6 weeks, his rx had to be written by them and not his PCP and if he was in the ER for something they were notified.
Hes off the heavy pain meds now, he was on a fetanynal patches starting at 75 mcg, which is a LOT, for about a year and finally tapered off but it took a while. Now he just suffers and whines because he personally doesnt want to take anything stronger than tylenol and even then he bitches about it. (he is the complete opposite of drug seeking which is why he is healthwise today. )
So I do think opioids need to be more heavily monitored on an acute pain basis.
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jaygee
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Post by jaygee on Mar 20, 2019 8:43:57 GMT -6
I think part of the issue with limiting acute pain prescriptions is making sure there is a safe guard in case pain lasts longer. Like is there a way to get 1-2 days more efficiently if needed? In some cases probably not. Like I’m thinking of a person without a car or a lot of help and they realize at noon on day 7 that they need more. What happens? Do they have to go into the doc? The health care system doesn’t always move that fast.
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dc2london
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Post by dc2london on Mar 20, 2019 8:45:28 GMT -6
I think part of the issue with limiting acute pain prescriptions is making sure there is a safe guard in case pain lasts longer. Like is there a way to get 1-2 days more efficiently if needed? In some cases probably not. Like I’m thinking of a person without a car or a lot of help and they realize at noon on day 7 that they need more. What happens? Do they have to go into the doc? The health care system doesn’t always move that fast. my sister runs into a lot of problems getting one of her ADHD meds bc it is a highly controlled substance. And, as you may be able to predict, her ADHD leads her to not be great about time management and planning ahead so she somewhat routinely ends up driving all over town looking for a pharmacy that not only will fill the med but actually has it in stock.
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jaygee
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Post by jaygee on Mar 20, 2019 8:51:14 GMT -6
I’m sorry for everyone dealing with insurance woes and huge out of pocket expenses.
One thing I really like about the Medicare system is that the Out of pocket expenses are much clearer and predictable. And fairly reasonable. I’m not sure if the reasonable part will scale with a Medicare for all approach, but it’s one of the things I’ll be looking for in the proposals. Also, private insurance can be purchased as supplemental to Medicare, which covers the OOP costs.
The system we have is so messed up as you all have experienced. The incentives are really poorly aligned. Delaying preventative care or non-emergent care, which is what people have to resort to is a huge part of the cost in the system. It’s why integrated health systems are so successful (like Kaiser). They are incentivized to keep a patient healthy before issues become emergent and cost of non-emergent care is way less (not to mention better health outcomes).
Imo, the cost savings from having people be able to get routine care in a timely manner and the reduction of administrative costs for providers having to deal with hundreds of different insurance companies would more than pay for Medicare for All (or any single payor system).
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jaygee
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Post by jaygee on Mar 20, 2019 8:56:41 GMT -6
Yeah, I’ve been burned on the prescription drug thing before so access makes me nervous. Once my mom was discharged from the hospital with a prescription in a format that only a hospital pharmacy would carry. But it was 5 pm on Friday when we got home and I tried to fill the prescription. And the hospital pharmacy was closed for the weekend to non hospital patients. And then she ended up back in the hospital in two days. So, that sucked.
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Post by flippinchica on Mar 20, 2019 8:58:50 GMT -6
I think part of the issue with limiting acute pain prescriptions is making sure there is a safe guard in case pain lasts longer. Like is there a way to get 1-2 days more efficiently if needed? In some cases probably not. Like I’m thinking of a person without a car or a lot of help and they realize at noon on day 7 that they need more. What happens? Do they have to go into the doc? The health care system doesn’t always move that fast. Right and schedule 2 meds need a physical paper prescription so the patient or family member needs to a actually come to the office. Poofed details My other issues with this bill is it is legal rules getting in between a patient and his doctor the same as abortion laws do. Though there certainly are pill mills where drs get greedy and that is not ok so there is a line to be drawn. Two of the biggest causes of increased opioid prescribing was the push for pain score as the fifth vital sign and them emphasis on patient satisfaction as a measure to grade hospitals and doctors. So I'm not sure more regulations like that will solve without putting more burden on patients.
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jaygee
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Post by jaygee on Mar 20, 2019 9:01:50 GMT -6
cakewench, maybe I’m assuming, but changing the guidelines for prescribing for acute pain shouldn’t affect chronic pain prescriptions. She’s just saying that for something like dental work or surgery, 7 days should do it. I assume at the end of that you could go back and be evaluated it more is necessary. People really are getting a months supply for wisdom teeth and other minor surgeries. I’m not questioning you, but the last part about people getting months supplies for minor surgeries I do have questions about. Does that really happen? It hasn’t been my experience but maybe mine and H’s docs are really conservative. Fun fact: I have a really bad reaction to Vicodin and can’t sleep on it so I don’t get to take it when I have surgery. 😢
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jaygee
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Post by jaygee on Mar 20, 2019 9:05:01 GMT -6
I think part of the issue with limiting acute pain prescriptions is making sure there is a safe guard in case pain lasts longer. Like is there a way to get 1-2 days more efficiently if needed? In some cases probably not. Like I’m thinking of a person without a car or a lot of help and they realize at noon on day 7 that they need more. What happens? Do they have to go into the doc? The health care system doesn’t always move that fast. Right and schedule 2 meds need a physical paper prescription so the patient or family member needs to a actually come to the office. There is a patient at work having a limb lengthening procedure and they live 2 hours from the office. She is doing the lengthening for a bit over a month and that part is painful. so opioids are appropriate for that time. My other issues with this bill is it is legal rules getting in between a patient and his doctor the same as abortion laws do. Though there certainly are pill mills where drs get greedy and that is not ok so there is a line to be drawn. Two of the biggest causes of increased opioid prescribing was the push for pain score as the fifth vital sign and them emphasis on patient satisfaction as a measure to grade hospitals and doctors. So I'm not sure more regulations like that will solve without putting more burden on patients. I had the exact same thought about interfering with doctor and patient decisions. I know this is a huge problem, but this bill seems not the way to attack it.
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jkjacq
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Post by jkjacq on Mar 20, 2019 9:05:40 GMT -6
dont get me started on filling ADHD rx's, when T was in them I used to have to drive to his provider once a month to pick up the paper copy, then take to the pharmacy and I had to remember to call the dr at least 72 hours prior to needing it written let alone filled. It SUCKED
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jaygee
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Post by jaygee on Mar 20, 2019 9:07:28 GMT -6
Hi guys. I’ve been on a bit of a news hiatus. After the mosque attack I got extremely overwhelmed with doom and dread. But happy to be back talking about my favorite topic - health insurance. Lol.
On the good news front I’ve been spending a ton of time volunteering for the dog rescue and it’s making me very personally fulfilled.
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redbears
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Post by redbears on Mar 20, 2019 9:09:40 GMT -6
dont get me started on filling ADHD rx's, when T was in them I used to have to drive to his provider once a month to pick up the paper copy, then take to the pharmacy and I had to remember to call the dr at least 72 hours prior to needing it written let alone filled. It SUCKED That sounds really annoying. Did he have to pay a co-pay for the doctor every month or could he just pick up the script?
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jkjacq
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Post by jkjacq on Mar 20, 2019 9:10:15 GMT -6
I think overall there may be a push to 'better' pain relieving drugs? Admittedly I have a pretty high pain tolerance so Tylenol 3 works for me but it could be the fact that we as a general are more in instant gratification mindset lately and T3 doesnt work as fast as Oxy and it doesnt give you the high either?
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jkjacq
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Post by jkjacq on Mar 20, 2019 9:10:59 GMT -6
dont get me started on filling ADHD rx's, when T was in them I used to have to drive to his provider once a month to pick up the paper copy, then take to the pharmacy and I had to remember to call the dr at least 72 hours prior to needing it written let alone filled. It SUCKED That sounds really annoying. Did he have to pay a co-pay for the doctor every month or could he just pick up the script? Thankfully no But he started concerta when it first came out so there was no generic at the time so it was 150/month for the rx.
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Post by notblanche on Mar 20, 2019 9:12:42 GMT -6
cakewench , maybe I’m assuming, but changing the guidelines for prescribing for acute pain shouldn’t affect chronic pain prescriptions. She’s just saying that for something like dental work or surgery, 7 days should do it. I assume at the end of that you could go back and be evaluated it more is necessary. People really are getting a months supply for wisdom teeth and other minor surgeries. I’m not questioning you, but the last part about people getting months supplies for minor surgeries I do have questions about. Does that really happen? It hasn’t been my experience but maybe mine and H’s docs are really conservative. Fun fact: I have a really bad reaction to Vicodin and can’t sleep on it so I don’t get to take it when I have surgery. 😢 I don't know about months' supplies but I've had doctors prescribe opioids even when I say I won't take them. The OB who delivered M wouldn't let me leave the hospital without the opioid, even though I'd taken nothing but ibuprofen for more than 48 hours. I argued with her about it. And then I returned them, unopened, at a take-back event a few months later. These prescriptions are written far too liberally.
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dc2london
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Post by dc2london on Mar 20, 2019 9:14:14 GMT -6
jaygee I often point to Kaiser as evidence supporting a single payer system
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jaygee
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Post by jaygee on Mar 20, 2019 9:19:27 GMT -6
I’m not questioning you, but the last part about people getting months supplies for minor surgeries I do have questions about. Does that really happen? It hasn’t been my experience but maybe mine and H’s docs are really conservative. Fun fact: I have a really bad reaction to Vicodin and can’t sleep on it so I don’t get to take it when I have surgery. 😢 I don't know about months' supplies but I've had doctors prescribe opioids even when I say I won't take them. The OB who delivered M wouldn't let me leave the hospital without the opioid, even though I'd taken nothing but ibuprofen for more than 48 hours. I argued with her about it. And then I returned them, unopened, at a take-back event a few months later. These prescriptions are written far too liberally. Yikes. Wow. That’s a problem. I wonder though if she does that because if you change your mind in the middle of the night, you are screwed. But still...if you hadn’t been taking them it doesn’t seem like she should have prescribed them. (Speaking as a non medical professional).
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richard
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Post by richard on Mar 20, 2019 9:35:01 GMT -6
I want to see a Medicare buy-in program pronto in 2020 if Dems win.
Clearly that's not the full solution for people under 50 but it would be a big step in the right direction and we could see how Medicare functions on a larger scale. It could also pull older people out of the ACA exchange and make those rates more affordable for younger people.
ETA: plus it's popular, like 80% of people are for it
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Post by oreobitsy on Mar 20, 2019 9:35:51 GMT -6
This doesn't even include all the investigations into inaugural funds, tax fraud, hush money.
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jkjacq
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Post by jkjacq on Mar 20, 2019 9:37:57 GMT -6
I want to see a Medicare buy-in program pronto in 2020 if Dems win. Clearly that's not the full solution for people under 50 but it would be a big step in the right direction and we could see how Medicare functions on a larger scale. It could also pull older people out of the ACA exchange and make those rates more affordable for younger people. I'm SO DOWN with Medicare buy-in. I'll be 50 in 21 so it could impact me immediately if they can get it done.
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Post by 100poppies on Mar 20, 2019 9:48:43 GMT -6
jaygee, I think you’ve been lucky with doctors. My SIL has her gallbladder out last year (endoscopic) and her dr offered her a few weeks of an opioid as the first option in pain management. She declined (totally paranoid about addiction) and took ibuprofen for two days. I was offered an opioid after childbirth, and had absolutely no need of it. It might be area specific, we both live in huge abuse areas, but in both cases we didn’t need it or go looking for it and felt like drs were far to quick to offer.
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AmyG
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Post by AmyG on Mar 20, 2019 10:06:21 GMT -6
I think overall there may be a push to 'better' pain relieving drugs? Admittedly I have a pretty high pain tolerance so Tylenol 3 works for me but it could be the fact that we as a general are more in instant gratification mindset lately and T3 doesnt work as fast as Oxy and it doesnt give you the high either? Codeine in tylenol 3 is an opioid.
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dc2london
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Post by dc2london on Mar 20, 2019 10:15:52 GMT -6
This Kushner, Inc book is going to be a real humdinger
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jkjacq
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Post by jkjacq on Mar 20, 2019 10:22:38 GMT -6
I think overall there may be a push to 'better' pain relieving drugs? Admittedly I have a pretty high pain tolerance so Tylenol 3 works for me but it could be the fact that we as a general are more in instant gratification mindset lately and T3 doesnt work as fast as Oxy and it doesnt give you the high either? Codeine in tylenol 3 is an opioid. You are right. Codeine has been around for so long I think I just look at it as 'light'. Does that make sense? Like codeine works well but lets make a stronger one and give it to everyone. (I dont mean people who suffer from long term illnesses in this, I'm strictly speaking removing your wisdom teeth type thing)
Disclaimer I dont do well with rx strength painkillers. They make me crazy so I try to stay away as much as possible.
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