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Opioids Drs can be idiots

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My3sons

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Nov 18, 2015
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So one of my patients comes in the other day and she is clearly drug fishing! She had a minor procedure one week prior (b/l flank lipo) mind u in our office not the OR. Barely had anything out! She asks for refill of T3 and goes overboard with the whole "I don't take pills" bullshit. So he tells her "I can't give you a T3 refill but heres dilaudin!" I was floored! Little does he know I am n MMT! Am I not as knowledgeable as I think I am or is he an idiot! Talk about being her lucky day!
 
I would say to continue keeping your intelligence under wraps and I say this for many reasons. One being it causes people to underestimate you and another one is its none of their damn business what you know.

Interesting story though.
 
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I didn't say a word! Pretty sure he would lose confidence in me scrubbing in for surgery bc mmt has such a negative rap!
 
Chadd said:
I would say to continue keeping your intelligence under wraps and I say this for many reasons. One being it causes people to underestimate you and another one is it's none of their damn business.

Interesting story though.
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I agree with this. Especially at your place of work/employment. :)

I used to work in a pharmacy as a tech and it was seriously crazy the number of scripts different people would come in with for opiates and benzos. I told the one pharmacist that they seemed way too over prescribed and he agreed but he said how we do not have much choice but to fill them.
 
This is exactly how some unwitting people become opiate dependent.

There should be a 2-3 week course dedicated to opioids, their uses, bioavailabilities, potency, interactions etc. required for any doctor to prescribe them (USA bupe docs have to do something similar despite bupes wide therapeutic window and lower potential for abuse)
 
Keep in mind that many drs receive kickbacks, and percentages, for writing certain 'scripts..



- Hopeless Soul
 
This although less absurd happened during work in a pharmacy supply place. All the supossed goodies (opiods. stimulants and flunitrazepam a.o) were in secured area. But as I walked passed the shelves there was lormetazepam, nitrazepam, midazolam, ketamine and codeine. Still wondering were the meprobamate and temazepam were stored? Wasn't that knowledged back then and didn't look.

All equally desirable substances one would say. Your case one lucky lady mine envy to the whole steady gang working at that medi pharm.
 
My3sons said:
"I can't give you a T3 refill but heres dilaudin!"
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Also if he knows nothing about pharmacology and opiates he has to know that dilaudid is an higher schedule then t3, the script is different.... really strange.
 
emkee_reinvented said:
All the supossed goodies (opiods. stimulants and flunitrazepam a.o) were in secured area. But as I walked passed the shelves there was lormetazepam, nitrazepam, midazolam, ketamine and codeine. Still wondering were the meprobamate and temazepam were stored?
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Legally this makes sense, only schedule II have to go in a safe.
 
It sounds like the Dr is getting a percentage from the dilaudid supplier.. what Dr in their right mind would say no to T3, and in the same breath, say yes to hydromorph'?


- Hopeless Soul
 
7nos-SS373dOH said:
Keep in mind that many drs receive kickbacks, and percentages, for writing certain 'scripts..



- Hopeless Soul
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Nah, this isnt true anymore. Pharma still has ways of paying doctors but you need a really shady doctor to meet a really shady sales rep for kickbacks to happen these days. Not saying it never happens, but really rare. And Dilaudid has a generic, so its not even promoted anymore.
 
I once had a doctor tell me I needed to take benzos everyday for them to work, because that's how anti-depressants like clonazepam function. The doctor told me not to worry, because if I ever had to go off them, they don't bring on withdrawals anyway.

If you're reading that and thinking I messed something up, I didn't. That's pretty much verbatim what the doctor told me. So I'm not too surprised by anything I read regarding the actual level of knowledge of some doctors.
 
I had a nurse tell me when I was filling out a contract that xanax didn't typically cause withdrawal and my then doctor pretty much told me it was mostly psychological. He was an alright doctor besides that, but holy sheeit.
 
Kittycat5 said:
Nah, this isnt true anymore. Pharma still has ways of paying doctors but you need a really shady doctor to meet a really shady sales rep for kickbacks to happen these days. Not saying it never happens, but really rare. And Dilaudid has a generic, so its not even promoted anymore.
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Ever hear of a suboxone Dr?


-HS
 
Yes. That isnt exactly the same thing. Yes, much of the training was developed and funded by RB and for many years they had the only products available, but most doctors go through the training to actually help their patients and/or to personally make more money. And now there are alternatives to RBs products, the generic buprenorphine or bupe/naloxone tablets and Zubsolv, and while Suboxone film still holds much of the market, a doctor can choose any of these drugs.
 
Yes there is alternatives, and yes they can choose, all's I'm saying is, some choices are more profitable than others.


-HS
 
True, but only to the pharmaceutical companies. Unless a doctor is one of a drug company's paid experts, an office visit is the same cost to the patient regardless which script he writes. And certainly not to the pharmacy, where they are lucky to make 10% on the 400 dollars 60 Suboxone films cost, and usually more like 3-7%. Zubsolv is no better. Only the generic bupe/naloxone generally has a higher gross profit % but brings in potentially less actual GP dollars as they much cheaper
 
The only kickbacks these days is when the reps bring lunch! Which sucks anyhow bc you lose your free time bc it becomes a working lunch! We all hate when the reps come and try to tickle the docs asshole! Which reminds me, we have one today. Boo
 
I just can't puzzle out a good reason for the "no" to a T3 script unless it was acetaminophen related. Anecdotes like these continue to give me WTF wrinkles on my forehead, even though I was told by two different nurses at a scene that they "didn't start CPR because he didn't have a pulse". Ouch.
 
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