Ive ghosted the forum for years with only the occasional post, but the past year or so it seems that Im reading more and more stories in the media regarding doctors getting in trouble with the DEA for prescribing what would to the general public seem to be abnormally high dosages of opioids to a large portion of their patients, and even reading in this and other drug-related forums that people who's PM doc is prescribing these abnormally high dosages of opioids to are being almost automatically dismissed as pill mill docs, in it for the money, or easy tickets for getting high. Im not saying everybody is assuming this, but it seems to be at minimum an upward rising trend almost everywhere I turn to scrutinize without fail the higher dosing of these medications for non-cancer related illnesses. As if living a life in excruciating pain isn't somehow on the same level as having a terminal illness such as cancer pain-wise physically.
My close friend has been a pain patient for the past 3 years or so after going years suffering because he was considered too young (was only 27 at the time) to be suffering, as if age had anything to do with it. He is a Type 1 Diabetic, and has been since he was 7 years old, and suffers not only from diabetic neuropathy ( a really tough problem to alleviate), but has two severely herniated discs from an exercise accident in his lower lumbar that cannot be fixed without surgery that his neurosurgeon has recommended against at least for the time being.
He also happens to be highly deficient in his CYP350 chromosome that metabolizes many opioids, as he was given a test by his PM doc (who is excellent btw) because higher than normal doses of opioids were not giving him sufficient pain relief, and now with technology advancements, we can now see that a very large portion of the population, especially of Northern European descent are deficient in this or another enzyme responsible for the metabolization of various opioids, causing a need for increase, sometimes to very large levels... .as we now know that there really is no ceiling for pain relief for most opioid medications...
He has received criticism and down right condescending lectures from other docs regarding his large opioid tolerance, but this just goes to show how little most PCP's know about pain management.
I dont know his exact dosing, but I know its approximately 3 x 80mg OP's spaced evenly daily, times daily and 8mg Dilaudid 2-3 times per day as needed, and 10 mg Opana IR for breakthru pain....along with 60mg Adderall in the morning.
That is a lot by almost anybodies standards, but for him it works well keeping his pain around a 3/4 out of 10 nearly all day.
Here are some articles of studies done by one of the most well known and respected PM docs in the country on this very issue...http://http://www.practicalpainmanagement.com/treatments/pharmacological/opioids/genetic-screening-defects-opioid-metabolism-historical
Actually, here is the list of all his written studies, all very good reads for those interested...
I just felt that it was not spoken of enough and too many people were being labeled as drug seekers and good, responsible, caring doctors were losing their careers over something hardly anybody in the medical establishment talks about outside of pain doctors, especially not the morons at the DEA.
Take Care and God Bless.