I am just here for a refill!

We are still all in it together, at least as best as I can tell from recent experiences.  In the past few weeks I have had several deja vu encounters, occurring in separate emergency departments in different states.  Most recently, I was coming on shift and taking sign out from a colleague who informed me of a challenging discussion. A patient was insistent that he was to get his narcotic prescription refilled, that the original prescriber was not reachable, offering no means for the patient to get in touch, and of course, to just go to the emergency department (ED). Despite the patient acknowledging that he had not taken the medication as prescribed and that the sixty tablet prescription was to last another week or so, but was already metabolized, he remained steadfast, that he must get a refill immediately.  The patient was not in extreme pain nor compromised to any concern whereby refilling the prescription most definitely was not a consideration. 

Pharmaceutical price gouging continues to force the toll on the most vulnerable.

Despite more social media coverage and public outrage regarding the rapid and egregious rise in pricing for many of the most commonly prescribed and generic medications, there is no immediate solution on the horizon.  Providers and patients are usually the last to become aware of the details.  “No wonder, Dr.

The End Game

“He was perfectly fine this morning, and a bit tired this afternoon, which made sense.  I went in to check if everything was okay and found him lying in bed having trouble breathing clutching his chest.  That’s when I called 911.  Of course I want everything done that can possibly keep him alive.” These were the words and wishes of the patient’s family member.   This was a man in his tenth decade of life, unable to speak for himself, facing momentary demise, with no clarity of how involved or intense the resuscitation process should be.  A man barely alert, in pain, with few chronic medical problems, in his mid-nineties, supine in an emergency department resuscitation bed.  There was no way to determine what he really wanted for himself under such circumstances, leaving the timely decision up to family and friends, who reportedly had not discussed such possibilities in the past nor made reference to what he might have wanted based on his character in general.  End-of-life care decis

The usual suspects, who are they really?

While walking into the emergency department (ED) for a Friday night shift, I heard the patch on the EMS radio reporting a patient found down, unresponsive, not breathing and cyanotic on the sidewalk.  An initial dose of naloxone had restored the patient’s respiratory drive, but ongoing resuscitation was in progress, with a five minute ETA.  For me, the prehospital EMS providers and my department colleagues, it was yet another shift treating a patient with an acute life threatening opioid overdose.  Over the next five hours of the same shift, there were three more opioid overdoses, each as severe as the first. All required supportive care and were eventually discharged from the ED. Fortunately, none died, unlike others in the days and weeks before.  Three of the four patients had a history of being prescribed, or using illicitly, methadone and/or buprenorphine, with no recent or related history of abusing prescription narcotics.

The Many Faces of Addiction

The New Hampshire Medical Society’s Annual Scientific Conference is just around the corner, scheduled for Nov 6-8, at the Sheraton Portsmouth Harborside.  The focus, The Many Faces of Addiction, couldn’t be anymore necessarily relevant and timely.  It is an opportunity to have expert speakers from several different vantage points address core issues regarding the spectrum of circumstances impacting the addiction epidemic. It will also offer a forum for those in attendance to share their insight and practice experiences with the speakers, to have an interactive exchange of what the biggest barriers are in reducing the number of people using and abusing opioids in New Hampshire, with an increasing monthly mortality rate.

SSDD - Same Story, Different Decade

The endless swirl of competing issues can make it a dizzying task for even experts to remain focused while working to achieve reasonable solutions to slow down the steamrolling opioid and heroin epidemic.  Stakeholders have been swept up into a tornado-like momentum which, quite frankly, has been fueled in part by the tug of war between controversial public health platforms that are decades old.  The push to acknowledge undertreatment of pain served to offset consistent regulation in prescribing opiates and potentiate erratic prescribing patterns along with growing a largely unregulated multibillion dollar niche market of pain control practices.

Next Available For Those Who Really Need It!

More elderly patients with substance abuse issues are using the emergency department for their only means of intervention.

Pay Attention to Heard Mentality- Don’t Believe Everything You Hear (or Read)

There is a voluminous amount of information describing the risks of vaccinations that really has no consistent evidence based support. There is a myriad of shock and awe anecdotal correlates of how lifelong debilitating disorders are connected to childhood vaccines.  The word is “heard.”  So and so heard it causes…, and they told two friends, who read and said and more and more heard that there is no need to vaccinate children or those at greatest risk of contracting some of the most deadly and communicable diseases.  Those are the diseases that killed millions, with real data supporting the prevention of spreading the same diseases and saving many more lives through vaccine programs.  Meanwhile, thousands of people are dying yearly who are not fortunate enough to receive vaccinations, but would line up with their families for the opportunity if available.  What a shame it is.

Hand in Hand

It is not getting any easier to adequately address the needs of patients with mental illness.  The challenge is exponentially heightened for those in acute need, who turn to community health centers or office based practices, only to be redirected to the ultimate repository for many more these days-- the emergency department.  In fact, the circumstances are getting murkier.  With the addiction epidemic remaining at full throttle, more patients are in need of timely resources suited to help on more than one front as the two frequently go hand in hand. 

Drug Money

There are several perplexing circumstances pushing the cost of healthcare further into the stratosphere.  However, one entity in particular has a notable historic record of being incredulously bold in taking advantage of the greatest number of those most in need, for decades.  Pharmaceutical manufacturers are taking liberties to make billions at the expense of creating outrageous financial hardship and jeopardizing the health of millions of people.  Following a blog of several weeks ago, I have continued to share in discussions, with many providers and patients, of how devastating the impact from price fixing by several pharmaceutical companies is.

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