#21: Music is the Best Medicine?

Well it has happened again.  A group of providers has discovered another way to stop the raging abuse of drugs.  Music.  That’s correct.  The very first sentence in a paper by a group at the University of Pennsylvania, published in, Regional Anesthesia and Pain Medicine, Volume 44, Issue 8, states, “Music medicine is a nonpharmacologic intervention that is virtually harm-free, relatively inexpensive and has been shown to significantly decrease preoperative anxiety.”  Really?  Please say it ain’t so!!  When I am laying there waiting to be sliced open by a surgeon holding something that could be found in Bob Villa’s toolbox, I am sure that listening to Lionel Richie sing “All Night Long” will take me to a place that a milligram or two of Versed won’t.  Uh huh, sure it will.  NOT!!

The FDA has now gotten hold of this well studied and thought out paper and decided to deliver a megabuck grant to study mice prone to falling asleep when listening to Led Zepplin, or maybe it was Whitney Houston.  Okay, not really.  What happened to appropriate, well thought out medical care.  Yes, abuse of a benzodiazepine can cause respiratory depression, however surgery is done in a hospital or surgery center where patients are routinely knocked out and breathing is done for them, not in a garage.  Additionally, how many of you reading this, have heard of an incident where abuse of Versed in a surgical setting has caused respiratory depression?

I realize, and hopefully you do too, that I am being mildly, maybe even moderately sarcastic, however I have to wonder has the medical world gone bat#### crazy?  Where has the ability to think for oneself gone?  How about this one: A 2017 Journal of American Medical Association paper reached this following conclusion, “To treat emergency room patients in acute pain, a single dose of oral opioids is no better than drugs like aspirin and ibuprofen.”  I kid you not.  

Perhaps the authors of this study were using their own products?  I have to ask, who in the world goes to an ER in legitimate acute pain and receives an aspirin for that pain?  This is another example of how the opioid hysteria has influenced the medical society.  I am not saying that distribution and use of controlled substances should not be appropriately done, however, keep me away from the ER provider who wants to slip me 1000 mg of Tylenol vs one 15 mg Oxycodone for a kidney stone. 

That would be like claiming the Boston Red Sox are better than the New York Yankees.  Everyone knows that would not be true unless the Yankees played with blindfolds on. 

      

Anyway, welcome to fall everyone.  Please enjoy your weekend.  Say hi to someone you haven’t seen in a bit.  It will do you both good.

 Thank you for using Industry Lab as your toxicology lab.  We do appreciate your business.

Lance Benedict

President/CEO Industry Lab Diagnostic Partners 

10/18/2019

#20: Recognizing Drug Seeking Behavior

I have stated it before, however it is worth repeating; “Dependency on prescription drugs can occur at any age, within any cultural group and across any educational class.”  Drugs do not recognize color, social status, economic standing or educational prowess.  They do not discriminate.  No one is immune to the potential risk associated when taking a mood/mind altering drug.  Are you able to recognize drug seeking behavior in your patients?  What about your neighbors?  How about the person that babysits your child for hours at a time? Okay, now I have your attention.  In today’s society, it is almost guaranteed all of us run into someone taking some type of mood altering drug, either legally or illegally on a daily basis. 

The first step in learning how to recognize drug seeking behavior is to realize, and accept the fact, it exists. Individuals who express anger when questioned closely about pain symptoms they are complaining about. Patients asking for specific drugs by name, while claiming no others work.  Perhaps you have patients asking for an increase in the dosage of their meds on every visit, claiming the prescribed meds are, “Just not strong enough.”  Then there are those who make excuses why they can’t take alternative drugs, such as claiming multiple allergies.  Do you know anyone who uses a controlled substance for something other than for what it was prescribed, such as enhancing one’s mood or using an opioid to help one sleep?  What about the individual who takes extra, because one “just isn’t strong enough” or someone you know asking you about your prescribed medication and might they be able to have what you no longer take? Anyone involved in pain treatment has seen the patient who is focused more on getting drugs, than on the problem the drugs were prescribed for.

None of these behaviors alone would stand up as the definition of drug seeking behavior, however when you begin to see two or three of them exhibited by a patient or someone you know, it should raise suspicion.  I once had a patient, actually the woman who sold me my house, come in for pain treatment and request Percocet because “Hydro” just wasn’t strong enough.  She went on to say, before we even offered, that epidural steroid injections, facet blocks, physical and chiropractic therapy, and any other physical treatment wouldn’t work on her.  Percocet 10, three times a day were the only thing that worked for her.  Yes, she was that specific.  Needless to say her urine drug screen and confirmation came back a bit “dirty”.  I was so disappointed.  As we could not offer her any pain or anxiety medication she refused any of the many other treatments we had available.  Sadly she passed away about a year later from an overdose of opioids.  

Not everyone’s drug seeking behavior is so obvious and it takes experience to recognize it.  Everyone gets fooled so do not beat yourself up if it has happened to you.  Don’t judge, be attentive, and learn from every encounter. 

We appreciate your business.

Lance Benedict 

President/CEO Industry Lab Diagnostic Partners​  

10/4/2019