Doctors who use are sometimes better doctors?

[justdifferent]

To make my point I'll have to generalise a bit, and would like to emphasise that of course there's plenty of doctors who are addicts or just users.
That aside, at least in Australia, there's an increasingly witless ideology - especially with younger doctors. One example is the notion that the best doctors are personally naive -as in inexperienced - about both addiction and recreational use of habit forming meds. This is meant to make them the most responsible prescribers, mysteriously. So they'll blithely dispense all manner of mind altering drugs - especially anti-depressants, and of course anything that's "new" is always heavily pushed. They idiotically rely on marketing "information" - ie can't distinguish an advertisement from an impartial study. They're big on power trips, and just tune out when interacting with addictive patients, as if addiction was definitely not an illness, but a moral failure.
Eg: right now I'm meant to "weaning" off Tapentadol. They've been giving me Tapentadol like lollies for weeks and just REFUSE to discuss symptoms I may have, or even suggest non-chemical ways of making it easier.
The pain specialist who treated me for bad shoulder fracture two years ago had a strategy of a few days on oxy, then a few days on Bupenorphine, then back to oxy if I was still in a bad way, then Tapentadol, then bupe again...my pain was very well-managed and I found I had no significant w/ds. He'd evidently put some thought into managing pain without establishing a physical dependence.

Anyway, I'd be glad to from people who've used Tapentadol long term (ie over months) and how they went with w/d. Or even users who haven't w/d yet.
Online I've read of very spooky w/d symptoms like Restless Leg Syndrome, "rigors" (shivering?)

 

[justdifferent]

Ps would like to add that I'd love to find a forthright GP who'd recovered from addiction. But there's apparently an occupational duty for GPs to depersonalise their treatments and promote the stupid notion that just because we're obliged to trust them, this makes them infallible.
I've often wished nurses had more authority over managing meds. In a hands on life or death situation, I'd rather have a nurse than a doctor...

 

[Quere]

I agree entirely. I'm sure someone with personal experience of addiction would make a far better Dr when dealing with addictive drugs.

One question, why do you put weaning in quotation marks? Is the tapering schedule the Dr has put together too drastic for you? (Resulting in WDs).

 

[justdifferent]

Pps OxyContin debacle a case in point about doctors lazily relying on promotional material. Perhaps because many doctors come from affluence, they associate wealth with "decency". Whites sepulchres!
Sorry am feelin rather cross with doctors right now:

 

[justdifferent]

I agree entirely. I'm sure someone with personal experience of addiction would make a far better Dr when dealing with addictive drugs.

One question, why do you put weaning in quotation marks? Is the tapering schedule the Dr has put together too drastic for you? (Resulting in WDs).

Not

 

[Quere]

Ps would like to add that I'd love to find a forthright GP who'd recovered from addiction. But there's apparently an occupational duty for GPs to depersonalise their treatments and promote the stupid notion that just because we're obliged to trust them, this makes them infallible.
I've often wished nurses had more authority over managing meds. In a hands on life or death situation, I'd rather have a nurse than a doctor...

I know, it's terrible. Because they are oh so fallible.

My GP once prescribed my an antibiotic that could have put me into anaphylactic shock due to an allergy.

Or the psych Dr who prescribed me 3 x 0.5 mg clonazepam/day for long term use, without any discussion of their addictive (and other) dangers and despite the fact that whenever you read medical guidelines around benzodiazepine use they almost always say they should only be used short term.

I have never met a Dr who knew as much about drugs as me, which is sad. Nurses, and also pharmacists are often much more competent.

 

[justdifferent]

It's not exactly that it's too drastic. It's more that I like them, of course, and hate to "waste" them on weaning. If I knew what to expect with cold turkey I'd rather just enjoy the relief they're giving me psychologically as well as physically. I mean my current situation is shocking - fractured knee in DV incident, living in women's shelter, destitute, and deprived of contact with my daughter.
This is not a situation most GPs could grasp. But my current GP is very Polly Pure and wouldn't empathise with using painkillers for anything other than pain. It's "not nice" to do that sort of thing, and is taking the easy way out, and it's time for me to pull myself up by my boot straps, and above all it's just wrong to deviate in anyway from doctors' orders, because she's the expert about this painkiller she's probably never taken, and must be a bit dim to have messed up my life so badly.
Sorry for whining. She's not that bad.

 

[justdifferent]

I know, it's terrible. Because they are oh so fallible.

My GP once prescribed my an antibiotic that could have put me into anaphylactic shock due to an allergy.

Or the psych Dr who prescribed me 3 x 0.5 mg clonazepam/day for long term use, without any discussion of their addictive (and other) dangers and despite the fact that whenever you read medical guidelines around benzodiazepine use they almost always say they should only be used short term.

I have never met a Dr who knew as much about drugs as me, which is sad. Nurses, and also pharmacists are often much more competent.

 

[justdifferent]

Snap! My doc gave me Oxazepam and never said a thing about "short term". I was young then and hadn't a clue. Thought I could just stop them whenever, and ended up in a terrible state.

 

[Quere]

It's not exactly that it's too drastic. It's more that I like them, of course, and hate to "waste" them on weaning. If I knew what to expect with cold turkey I'd rather just enjoy the relief they're giving me psychologically as well as physically. I mean my current situation is shocking - fractured knee in DV incident, living in women's shelter, destitute, and deprived of contact with my daughter.
This is not a situation most GPs could grasp. But my current GP is very Polly Pure and wouldn't empathise with using painkillers for anything other than pain. It's "not nice" to do that sort of thing, and is taking the easy way out, and it's time for me to pull myself up by my boot straps, and above all it's just wrong to deviate in anyway from doctors' orders, because she's the expert about this painkiller she's probably never taken, and must be a bit dim to have messed up my life so badly.
Sorry for whining. She's not that bad.

Yeah I get that. My life has been far better while on opioids and for that reason I am on methadone maintenance. It helps a lot not having to worry about busybody Drs deciding what is best for me and trying to take me off opioids, although the addiction 'specialist' type of busybody Dr can also be quite bad haha.

I'm sorry to hear things have been so rough

 

[Jack123456]

I have never met a Dr who knew as much about drugs as me, which is sad. Nurses, and also pharmacists are often much more competent.

In what way?

 

[HoldBack]

Snap! My doc gave me Oxazepam and never said a thing about "short term". I was young then and hadn't a clue. Thought I could just stop them whenever, and ended up in a terrible state.

I would take a doctor who is not an active or former addict to one who is an active or former addict 100% of the time.

The quality of care I’ve received (primarily in rehab facilities) has been much lower with addict doctors (and that extends to staff like counselors and nurses).

I do not believe a drug using doctor correlated with better outcomes in treating drug using patients.

That being said, I really wish there were a way for a doctor to experience withdrawal without becoming addicted. The extent to which withdrawal is not just avoided but actually terrifies patients cannot be understated. And a doctor whose never gone through tends to either say suck it up, it won’t kill you (non-gaba drugs) or that you deserve the withdrawal for use of the drugs.

No, no one “deserves” to be subject to withdrawal.

I wish there were a way to do it like police officers and tasers. Before officers can use them, they must get tased themselves to understand what they are doing to people upon activating their weapon.

If possible, such a practice would stop doctors from recklessly prescribing them cutting patients off benzos.

 

[Nicomorphinist]

Addicts, habitués from having chronic pain themselves, thorough men and women of science who do their due diligence by taking the drugs themselves at some point -- that helps and I have said that people who are responsible for taking people on and off narcotics including lawmakers should be shot up with morphine four times a day for two years and then given a nalorphine or naloxone challenge test a week before their licensure examination or taking the oath of office.

There are very good doctors, including ones in the USA who are indignant and fighting back against being terrorised for taking care of their patients. Not enough of them, which is why some are retiring, and some of them, and patients as well, are leaving the country permanently.

Any doctor who would take a patient off of benzodiazepines willy-nilly is committing malpractice and attempted murder because it is well-known that the abstinence syndrome is potentially fatal, and this goes treble for doctors, nurses, and insurance people who kick people off of carisoprodol, which is a carbamate sedative-hypnotic and meprobamate pro-drug and has a spectacular and exceptionally dangerous abstinence syndrome. Narcotic withdrawal does kill people as well with strokes of apoplexy, heart attacks, pulmonary embolisms, and other problems above and beyond the elevated suicide risk and any additional risk of accidents or being shot by cops if they try to implement the seek orientation, morbid or otherwise, and trying to get themselves better.

Just in general, when dealing with doctors and listening to anyone including nurses and media and political people, folks need to become sophisticated and educated consumers of information. It is necessary to do one's due diligence and know the history and actual facts. Something that should be obvious to reporters, editors, and people getting the information is that under no circumstances should anyone be touted as an expert and have disproportionate input into policy decisions who makes money and/or gains power and leverage over other people by running drug rehabilitation services or organisations, law enforcement and professional regulators like pharmacy examiners and state and provincial medical boards, suing doctors or manufacturers of medications or medical devices, nor (as helpful as they are in their proper sphere) purveying psychiatric services and any alternative medicine, particularly in a way which depends on them disparaging mainstream medicine and pharmacy. Especially medicinal cannabis, which is legitimate and of ancient standing, but is not a replacement for narcotics on the basis of its mechanism of action. That's just plain ethics and it shows how far gone the situation is in some places.

There is the money and power and corruption, but there is the sadism and misanthropy too, and some of these people making all of these problems are certainly mentally ill by the definitions of their own profession. Consider what the Milgram and Stanford Prison experiments show about human nature in general and that some of these people are 100 times worse and can do much more to people than give them 450 volts of electricity at 15 milliamperes . . . Think of places where you and/or others have worked and how it is feasible for people to be in positions of management or administration who have no business having any kind of power over people or even working with others to begin with.

In any case, when people start prattling about the fake opioid cri$i$ in front of you, don't let them get away with it. The fact that they do because people don't know any better, or they do and just feel so hopeless and bogged down when they get going on it is part of why things got the way they are. The difference betwixt a chronic pain patient and an addict is being thrown off their medicine or never being properly treated in the first place.

None of it is any good. All of the sound and fury has not allowed doctors any more leeway, which as professionals who went to medical school and are licenced to do their job they deserve anyways, to deal with patients with narcotic habits. The whole set up is and has been for 105 years at variance with and the horror of a good fraction of the rest of the world. And of course imperialism is part of this, with the drugs warriors in the US saying that other countries do not know as well how to deal with addicts so they should put pressure on them.

Is anyone surprised that any self-detox tool from poppy seeds to tianeptine and codeine people can get elsewhere to loperamide to kratom and the rest are being demonised and people are trying to outlaw them? So that they only option is their unscientific and cultish abstinence-only drug rehabilitation? With narcotics especially, all through history people including famous doctors, nurses, scientists and philanthropists and reformers have lived well and even better than otherwise for up to a century with a morphine, opium, codeine, medicinal heroin, pantopon, and/or hydromorphone habit. I've noticed that this is part of the biography of a number of people in America and Europe who were leaders in the fight against slavery -- co-incidence?

I'd rather have the metabolic hourglass of morphine &c over my head than someone else's ignorant and cultish idea about how I should live and endure pain and all that. A lot of these people are totally miserable folks and no one wants to be around them. Morphine, hydrocodone, nicomorphine, hydromorphone and all the rest make one love everybody and full of benevolent and expansive feelings and patience. Why should people have to live like these miserable, carping, retromingent, dog-fucking misanthropic satanic Communist terrorist vigilantes?

I am sure that the hot new treatment for addiction in 2020 is going to be trepanation. It only makes sense.

These prescription monitoring databases which allow bureaucrats to violate privacy and terrorise patients and doctors and chemists are only providing opportunities for corrupt doctors and pharmacists and inspectors to demand bribes, jack around patients, and -- for some reason with pharmacists dealing with benzodiazepine refills which is not completely clear to me -- demand blowjobs, prescription drugs diverted from elsewhere, and/or pot from customers, and calling doctors, family members, and employers if the customer pisses them off.

It is not heresy, and I will not recant.

 

[Quere]

Addicts, habitués from having chronic pain themselves, thorough men and women of science who do their due diligence by taking the drugs themselves at some point -- that helps and I have said that people who are responsible for taking people on and off narcotics including lawmakers should be shot up with morphine four times a day for two years and then given a nalorphine or naloxone challenge test a week before their licensure examination or taking the oath of office.

There are very good doctors, including ones in the USA who are indignant and fighting back against being terrorised for taking care of their patients. Not enough of them, which is why some are retiring, and some of them, and patients as well, are leaving the country permanently.

Any doctor who would take a patient off of benzodiazepines willy-nilly is committing malpractice and attempted murder because it is well-known that the abstinence syndrome is potentially fatal, and this goes treble for doctors, nurses, and insurance people who kick people off of carisoprodol, which is a carbamate sedative-hypnotic and meprobamate pro-drug and has a spectacular and exceptionally dangerous abstinence syndrome. Narcotic withdrawal does kill people as well with strokes of apoplexy, heart attacks, pulmonary embolisms, and other problems above and beyond the elevated suicide risk and any additional risk of accidents or being shot by cops if they try to implement the seek orientation, morbid or otherwise, and trying to get themselves better.

Just in general, when dealing with doctors and listening to anyone including nurses and media and political people, folks need to become sophisticated and educated consumers of information. It is necessary to do one's due diligence and know the history and actual facts. Something that should be obvious to reporters, editors, and people getting the information is that under no circumstances should anyone be touted as an expert and have disproportionate input into policy decisions who makes money and/or gains power and leverage over other people by running drug rehabilitation services or organisations, law enforcement and professional regulators like pharmacy examiners and state and provincial medical boards, suing doctors or manufacturers of medications or medical devices, nor (as helpful as they are in their proper sphere) purveying psychiatric services and any alternative medicine, particularly in a way which depends on them disparaging mainstream medicine and pharmacy. Especially medicinal cannabis, which is legitimate and of ancient standing, but is not a replacement for narcotics on the basis of its mechanism of action. That's just plain ethics and it shows how far gone the situation is in some places.

There is the money and power and corruption, but there is the sadism and misanthropy too, and some of these people making all of these problems are certainly mentally ill by the definitions of their own profession. Consider what the Milgram and Stanford Prison experiments show about human nature in general and that some of these people are 100 times worse and can do much more to people than give them 450 volts of electricity at 15 milliamperes . . . Think of places where you and/or others have worked and how it is feasible for people to be in positions of management or administration who have no business having any kind of power over people or even working with others to begin with.

In any case, when people start prattling about the fake opioid cri$i$ in front of you, don't let them get away with it. The fact that they do because people don't know any better, or they do and just feel so hopeless and bogged down when they get going on it is part of why things got the way they are. The difference betwixt a chronic pain patient and an addict is being thrown off their medicine or never being properly treated in the first place.

None of it is any good. All of the sound and fury has not allowed doctors any more leeway, which as professionals who went to medical school and are licenced to do their job they deserve anyways, to deal with patients with narcotic habits. The whole set up is and has been for 105 years at variance with and the horror of a good fraction of the rest of the world. And of course imperialism is part of this, with the drugs warriors in the US saying that other countries do not know as well how to deal with addicts so they should put pressure on them.

Is anyone surprised that any self-detox tool from poppy seeds to tianeptine and codeine people can get elsewhere to loperamide to kratom and the rest are being demonised and people are trying to outlaw them? So that they only option is their unscientific and cultish abstinence-only drug rehabilitation? With narcotics especially, all through history people including famous doctors, nurses, scientists and philanthropists and reformers have lived well and even better than otherwise for up to a century with a morphine, opium, codeine, medicinal heroin, pantopon, and/or hydromorphone habit. I've noticed that this is part of the biography of a number of people in America and Europe who were leaders in the fight against slavery -- co-incidence?

I'd rather have the metabolic hourglass of morphine &c over my head than someone else's ignorant and cultish idea about how I should live and endure pain and all that. A lot of these people are totally miserable folks and no one wants to be around them. Morphine, hydrocodone, nicomorphine, hydromorphone and all the rest make one love everybody and full of benevolent and expansive feelings and patience. Why should people have to live like these miserable, carping, retromingent, dog-fucking misanthropic satanic Communist terrorist vigilantes?

I am sure that the hot new treatment for addiction in 2020 is going to be trepanation. It only makes sense.

These prescription monitoring databases which allow bureaucrats to violate privacy and terrorise patients and doctors and chemists are only providing opportunities for corrupt doctors and pharmacists and inspectors to demand bribes, jack around patients, and -- for some reason with pharmacists dealing with benzodiazepine refills which is not completely clear to me -- demand blowjobs, prescription drugs diverted from elsewhere, and/or pot from customers, and calling doctors, family members, and employers if the customer pisses them off.

It is not heresy, and I will not recant.

Yeah the US decided to 'help' the rest of the world, not by asking other countries what they could do to help and then providing it but by enforcing their terrible puritanical rules on everyone else (it doesn't matter whether they want it or not, because we know best!!!).

The thing I can't stand about abstinence based philosophies is the fact that they can't play nicely with anyone else, just like medieval christians, they are the one true truth and anyone who doesn't believe what we do is a heretic!

When I was in one of these awful fucking 12 step rehabs, we'd be sitting in our 'therapy group' and it comes to my turn to talk:

I don't think I can cope with life off opioids, if there was some gear in front of me I would do it for sure.

Well then we can't do anything for you, why don't you just go out and relapse if opioids are so great. You'll go straight back to how you were, You'll be in the gutter with a needle in your arm within 48 hrs!!!

Ohhhkay. Well, I highly doubt that I would instantly go from fine to in a gutter just because of the administration of an opioid...
I mean I was addicted to opioids because they were fun and allowed me to function by reducing my depression and anxiety to tolerable levels not because they make me black out and wake up in gutters..
But anyway there's this thing called maintenance treatment with buprenorphine or methadone, I feel like I would do much better in such a programme and you guys keep saying you can't do anything for me.

(The whole room murmurs and chuckles smugly as though they've heard this a thousand times and only an idiot would see any kind of future in maintenance treatment.)

Just go out and use!!!

But surely being administered opioids under medical supervision would be a much better option than if i 'just go out and use'?

Everyone who goes on methadone stays on it forever and they all live together in shitty flats and inject their methadone and still do illegal opioids and none of them have jobs or achieve anything in life, is that what you want??!!! (This was the unilateral consensus of what awaited me if I went on maintenance treatment, they had to save me from the unthinkable, getting 'tricked by my inner addiction' into a lifetime of methadone addiction, unemployment and inevitably homelessness)

And here I am thinking, wow they really hate methadone! This doesn't really tally with all the medical information and research I've read on the effectiveness of maintenance treatment! Where do they get this terrible impression? What I realised is all these people had met methadone patients but what they failed notice was how they came into contact with these methadone patients. Of course they all met while using drugs, what business would a methadone patient who responded well to treatment - got a job, quit using - have hanging out with using drug addicts? None, so it stands to reason that all the methadone patients they had been exposed to were the minority, the ones for whom methadone treatment had not been particularly effective, who were still using drugs, unemployed etc

Confirmation bias anyone?

Being the self assured drug geek I am, I trusted my own research over their hysterical prophesies of doom at the hands of "the liquid cuffs"!!!!!!

And boy am I glad I did because all their rhetoric turned out to be nothing more than stigma and ignorance and maintenance treatment has been a game changer for me over the years.

But yeah my experience of 12 step organisations was that they prop up their extremely poor success rates in pretty much all empirical data by branding every alternative (and actually effective treatments) as 'not real recovery' or 'trading one addiction for another' and when their programme fails someone (like with me) they put the blame on the patient, because the programme is infallible!!! As they say in AA/NA "if the programme's not working.. it's because you're not working the programme!!!"

 

[Nicomorphinist]

These loud extremist folks who are making such a lucrative racket out of it all seem also to be big into the practise of the "intervention" which in plain English is called "false imprisonment" -- um . . . people who do that kind of thing in the service of both their pocketbook and inner bully and some grand ideology are generally looked down upon by human rights organisations and tend to have names like the Tonton Macoute, Mukhabarat, People's Commissariat of Internal Affairs, the Islamic State of Iraq & al-Sham . . .

Is there anything else anywhere in the economy where people ignore or are willing to accept paying well into the high quintuple figures in US dollars -- or more -- for something which sooner or later fails to deliver on its explicit promise 98 per cent of the time?

"Rehab . . . what a joke . . . Jesus Christ -- if you can come up with $30 000, you don't have a problem yet . . . just calm down and cool out a little bit . . ."

-- Sam Kinison, Houston 4. May 1990

 

[Nicomorphinist]

Even as politically incorrect as it may be in some locales these days, there are researchers looking at oxymorphone, morphine, buprenorphine, butorphanol, dihydrocodeine, and hydromorphone amongst other things as drugs for treatment-resistant depression. Narcotics actually were used medically for depression all the way into the late 1950s, and are either first-generation or modern anti-depressants a clear, indisputable improvement?

 

[Lorne???]

I agree w/ you n-morphinist, and many others

Addictive treatment doctors are the worst, I spent over 72 hours in a hell hole detox center. They gave me chlordiazepoxide (nordazepam) 15mg, even though I was prescribed 4mg per day of K-pins, and took triple that. Amount. And no opioids. They said (rather that motherfucker dr said) I would OD. On fucking Suboxone. He asked why I pissed negative and I had to remind him his test didn’t test for bupe(the hospital b4 was much more understanding)

I warned him, he ignored me. I hallucinated and eventually had a tonic clonic seizure. They gave me Ativan and increased my nordazepam dose...

Yeah, no pharmacist or doctor has came close to
My knowledge of drugs, except my current dr

Doctors who use are probably better, but how would you know?

Addictive doctors should have to develop an opioid or Benzodiazepine habit and be forced off cold turkey

And cold turkey benzo wd is malpractice, and attempted murder ?

 

[Nicomorphinist]

I have often observed that it seems that people who are against drugs know full well why people take them -- because they make them feel good. At some point some with drugs it may be to feel normal, but the overall idea is euphoria, so these people, the doctors guilty of this malfeasance especially, may have semi-sophisticated philosophical reasons in rare instances, but it is often just old fashioned jealousy -- why do people think that drugs and sex are so often mentioned in the same breath? And often by people whom no one wants to fuck in the first place.

 

[justdifferent]

Snap! My doc gave me Oxazepam and never said a thing about "short term". I was young then and hadn't a clue. Thought I could just stop them whenever, and ended up in a terrible state.

Oh and I live the breezy pseudo psychology they often go in for, and their touching belief that you can't read, let alone understand their special secret jargon.! Eg in hospital I read my notes and out of nowhere saw that I "possessed limited self-efficacy".
I guess if you rock up in hospital with a shattered leg and can't suppress your moans of pain as you wait for the doctor to finish her chat with a colleague about the pros and cons of teeth bleaching, and how great stock pots are in cold weather, it's pretty damning proof of shitty "self-efficacy".p

I would take a doctor who is not an active or former addict to one who is an active or former addict 100% of the time.

The quality of care I’ve received (primarily in rehab facilities) has been much lower with addict doctors (and that extends to staff like counselors and nurses).

I do not believe a drug using doctor correlated with better outcomes in treating drug using patients.

That being said, I really wish there were a way for a doctor to experience withdrawal without becoming addicted. The extent to which withdrawal is not just avoided but actually terrifies patients cannot be understated. And a doctor whose never gone through tends to either say suck it up, it won’t kill you (non-gaba drugs) or that you deserve the withdrawal for use of the drugs.

No, no one “deserves” to be subject to withdrawal.

I wish there were a way to do it like police officers and tasers. Before officers can use them, they must get tased themselves to understand what they are doing to people upon activating their weapon.

If possible, such a practice would stop doctors from recklessly prescribing them cutting patients off benzos.

Just wanted to say that I wasn't suggesting an actively addicted doctor would be better, but a recovered doctor-addict would be like gold for me. Not only would s/he know what the hell they were doing, and what effects and interactions to expect, but there might be good advice about w/d (not just "suck it up "). And an understanding of how addicts think.

 

[EggrollThunder]

I'd have to agree that a doctor that's had personal experience with things like addiction would probably be my go-to.