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Prescribing Narcotics in the U.S. - need opinions on continuing education

thisisabsurd

thisisabsurd

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Apr 7, 2010
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Mods, I apologize if this is in the wrong place...just couldn't decide where to put it.

I work in the medical field and I am considering going back to school so that I can have a job with prescribing authority. I do not want to specialize in pain management but pain meds will be an inevitable part of prescribing. I am also a chronic pain patient who has always taken a pretty low dose of pain meds to control my own pain. I mention this because I understand firsthand the frustrations of being a U.S. citizen in pain and all of the scrutiny and judgment and labels people like to impose.

Anyway, I do NOT have a conservative view on this at all. I personally feel like all illicit drugs should be legal and as far as prescribed pain meds, well, pain is really what the patient says it is. I would not be willing to put a patient who is in "legitimate pain" (American society's definition, NOT mine) through HELL for the 5% chance the patient might be drug seeking. Seriously, I was taught in school that clinical studies show only a 5% chance of becoming addicted to narcotics in a monitored, medically necessary scenario. Frankly, if an addict is withdrawing their pain is real too IMO. However, with all of this being said, I'm also not willing to break the law and risk my license and career so I am bound by whatever laws exist, wherever I happen to live.

So with all of the crackdowns on Rx prescribing and the DEA hassles, I am wondering if my philosophy would be better suited somewhere else in the world? Is there anyone on here with any experience prescribing in the U.S. that shares my philosophy on prescribing pain meds? Like I said, pain management is not a specialty area of interest for me, but it is a part of prescribing. I don't have the means to move somewhere else right away nor do I have the means for continuing education at the moment, but I have the ability to plan and save if that's what will be necessary. Possible options I'm considering for relocating: Canada, Europe, India?? Helping people is a passion of mine so it is important for me to get honest, firsthand accounts of prescribing around the world compared with the U.S.

Any and all feedback welcome! Thanks in advance.
 
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TCalderon- thanks for the reply. As an NP I would be able to prescribe just about any scheduled med in my state. NP is only one option of a few for me. I don't mean to sound evasive, but I would rather not list what my 2 earned degrees are in for the sake on anonymity. I realize that probably sounds really paranoid, but I don't feel like we live in such a "free" country anymore.

Do you have personal experience or secondhand personal experience with prescribing controlled in the U.S.? I am really wanting to know how much of a hindrance our laws have become to professionals who are bound by them. I am willing to save up and move to another country if it means I would be able to treat patients without being constantly harrassed. I am really interested in knowing the practicals of everyday practice in the U.S.and is it really such a big deal or are professionals still able to effectively perform their jobs?
 
I also want to add...

I have access to plenty of docs, NPs, PAs, RNs, etc. but everyone I have talked to has a VERY conservative view on this. I don't know if they started out with those views or were influenced into them over time. Regardless, they do not share my philosophy and therefore cannot really provide the perspective I am looking for.

I am not saying I would go "buck wild" on prescribing controlleds, not at all. But my understanding of how the system works now is intense scrutiny by DEA and I've even heard of some pretty nasty cases of harrassment. One could argue that practitioners who were initially compassionate and shared my views were beaten into submission by a system that doesn't understand treating pain (whether it be chronic or acute).

If a patient comes to me and tells me they are in pain, I would like to believe it would be as simple as me making a medical judgment and prescribing, based on the information the patient is giving me about their pain. Somehow I don't think it is that simple anymore in the U.S. Now if the same patient comes back asking for more pain meds, I would have to carefully consider what is really going on. Most likely it would be a scenario I would refer out to a pain specialist.

I just wouldn't want to become jaded or influenced by the system under which I would be bound.
 
An article I just found that lends some credence to my ideas on controlled substances in the U.S...

http://www.reuters.com/article/2012/06/16/us-dea-prescription-drugs-idUSBRE85F09220120616

I am not minimizing the seriousness of addiction. I am a chronic pain patient but I don't believe I've ever been an addict. With chronic pain management comes physical dependence, but physical dependence and addiction are independent of one another. One involves physiological need and the other involves destructive behaviors to satisfy that need. I'm no expert on addiction and that is why I would not even attempt to specialize in it. Anyhow...I'm hoping to get some more responses to my topic. :)
 
It is easy to say your not an addict while your getting a constant supply of your dose...once you run out is how you find out if your an addict or not imo.
 
Keep in mind no medical practitioner is allowed any longer to prescribe to themselves or any family. Only recently saw a news article about a respected doctor in the UK who got caught writing himself scripts (but using other doctor's names) for massive amounts of diazepam to feed his addiction, and lost his license.
 
Ok, I appreciate the responses but I'm really looking for what people have dealt with as far as the prescribing attitudes in the U.S. it isn't confined to opiates, there are many controlled substances out there. I hear a lot of complaints about prescribing in the U.S., not sure if it would be worth it to uproot and move somewhere else or if the same frustrations exist everywhere.

True on the point that it is easy to say one is not an addict while supply is there, but in my case the supply has not been there many, many times and I just deal with it. I've had the same doc for 8 years with no risk of losing the relationship because I have never gone to another doc to obtain Rx nor have I purchased anything from the street. So I am pretty confident to say I am not an addict.
 
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