Why should it not be appropriate? It's a really bad problem in the U.S. for CPPs - Chronic Pain Patients (there are 116 million CPPs who are untreated, poorly or incorrectly treated). I ought to know - I've been one now for 29 flippin' years! In fact the VA almost killed me around that, and they did, I'm morally certain, shorten my late wife's life by crippling me. The VA has a set of DSB criteria (Drug Seeking Behavior) that will eventually nail anyone on regular opiates. If you're a pain patient especially, you're screwed. Technically they review your DSB status every 3 years, but the letter I got from the head of the DSB board said, "We will remove the red flag when stop acting like an addict." That means when I stop needing opiates to control the pain. Just fyi, I have "massive nerve damage," severe arthritis and severe and crippling chronic pain. I've had 6 low back operations, at least three of them botched. There doesn't seem to be a lawyer on the planet with the cojones to sue the VA either. The VA's own directive (their standards for medical treatment) agrees with the civilian one, but the DEA has its own and they ignore the actual medical science behind CP treatment. They've learned that doctors and small clinic don't shoot back, and since they can steal assets even before a doctor has been charged and leave the doc destitute, it's seriously profitable. They share the money around to local cop shops, the school boards etc., so everybody gets at least a taste. The first thing they do once they've decided on another "Pill Mill doctor" bust is call the local media and make they're there. (This doesn't contaminate the jury, they say). They attack a clinic in full SWAT gear, drag half-dressed patients out of exam rooms and them and the patients and kids in the waiting room at gunpoint (gotta watch those little kids; they might haul an AK out their diapers and start blasting away!), steal patient records (another way to be sure no doctor will see the patients that are now medically abandoned). Normal billing practices becomes "money laundering," and regular opiate scripts or "high-dose"opiate treatment become "knowing and deliberate over-prescribing for no legitimate medical purpose." The DoJ prosecutor (especially in the case of the Pain Relief Network) as well as the Federal Judge are both vindictive and complicit, looking for another major media event. A judge can go into politics on it, and the prosecutor gets a lot of publicity as well. They go after mostly older doctors who've had some time to accumulate a home, a clinic and other property, maybe a boat and a small plane, savings and investments, they take it ALL so the doctor has no way to pay a decent lawyer.
The story is there at the remains of the Pain Relief Network and on doctordeluca dot com. The PRN is no longer a treatment advocacy organization (it was a (501)(C)(3) non-profit for that purpose, but the prosecutor beggared the surviving (until this last Christmas; she died in a small plane crash with her fiancee, an ACLU lawyer who helped in the case) founder, Siobhan Reynolds and the PRN nonprofit, so the blog is just there as a CPP chat for moral support and education. There are a lot of great exchanges and tons of information there, but that's it. No idea how long it'll remain up. I was a moderator, and wrote a lot of article and posted a lot. I'm one of three Administrators now.
Anyhow, once someone is labeled a "Drug Seeker" or there's an ADRB (Aberrant Drug-Related Behaviors) flag on the chart, the patient is reduced to begging for 30 Tylenol #3s for chronic pain. If it's the VA, the opiates can be precipito9usly discontinued, and the patient required to go through an "addiction evaluation." Every time that's happened to me, the "rehab center" they sent me to tossed me out after a couple of days with a note to DSB board that I had a pain problem, not an addiction problem. The Board always ignored it. An early experience at Sepulveda VA, defunct since the Northridge earthquake, was that they cut off the opiates, no titration at all, and when I went into withdrawals the doc in charge said, "See! You're an addict!" We had an Olympian fight over that and when the senior addictionologist came in he removed that and threw me out.
I was on fentanyl for some years and had been on a correctly titrated opiate regimen for a total of eight years before my wife became terminally ill, about 4 years ago. I had improved to where I was playing music on the weekends, helping out with a good-sized garden, trapping and relocating skunks as needed (and caring for feral cats and hauling them to the vets too), helping with cooking and housework - carefully. Right when my wife became bed-ridden, a new doc I had never met got the refill request for carisoprodol (generic Soma). The script had had a date limitation on it, but assumed I'd just bought 'em and scarfed 'em all down because I'd asked for a refill after the date ran out leaving a few hundred left I could never pick up. He actually called on the phone to tell me I was abusing them so I was off them as of right now. He refused to listen to me OR my regular doc when he got back from vacation. I was tricked into seeing a "Board Certified Pain Management Specialist who was no such thing - just an Internist with a year at a pain clinic. He cut the opiates I'd been on by more than 50%, removed the breakthrough pills ("You can't have a weak one AND a strong one - it's one or the other!") which is all totally contrary to the Medical Standard of Care and the VA's own directive. He crippled me, and I was only caretaker my bed-ridden had at the time. My house became toxic along with our clothes. I just couldn't do all that still feed and clean her. It got so bad we decided to take our own lives. We were about a week away from that when a local doc gave me enough help that I was able to keep her in the house she grew up in until she died in my arms, both as she'd wished. My weight, meanwhile, had dropped from 210 to 143 lbs - I'm six foot two. I'm still recovering.
I was recently remarried to a wonderful lady with six kids, three of whom are with us and three with the father by their own choice. We're looking hard at moving to Panama, a place that appears to be a lot more sane around pain treatment. I can't go through that again. I'm still not sure I've survived that last round of abuse. I'm back at the VA for non-pain related treatment ONLY. I have a pain doctor I see once a month, but I'm not sure how that will last either. He's been talking about a school he's going to and says he'll likely leave the field, and there ARE no other pain docs around that I'm aware of. Also, the DEA seems to be winding up for another country-wide "Pill Mill doctor" hunt. They'll be leaving the field in droves, not that they ever really quit - just slowed down.
A DSB or ADRB file is a medical blacklist. It's used that way, and once on it I've never seen anyone get off of it. In the VA records, that flag is still the very first thing that anyone accessing the file sees, and they have to sign in with their own SS#, which gets recorded on a permanent record. Or so I'm told.
My rant aside, did I answer you? Pardon if I ran of at the... ?... mouth? keyboard? Whatever. Anyhow, for whatever it's worth, there it is. There's a lot on Doctor DeLuca's site about this, and it's searchable. So Nvwhtohiyada - Cherokee for "Peace to you!"
Ian