DrugBuyers.Com: my very very very first time

is a little naive, don't you think? While prescriber's philosophies vary GREATLY along with their willingness to prescribe opiates (which is what I presume to be the issue at hand) there are numerous considerations that make a carte blanche, "if I feel I need them, I should get them" expectation unreasonable at best.

The doctor is "on the hook" for every prescription he writes, which includes exposure to potential civl, criminal, and regulatory liability should a patient be abusing, misusing, or harm should arise from, treatment.

It is very easy for pharmacists, many of whom are now PharmD (doctorate) graduates, why feel they posess, rightly or wrongly and sometimes in redheaded stepchild fashion, an equivalent insight into appropriate therapies and are eager to express their voice in their opinions of patient care. More than one doctor has had to defend himself to the medical board when an overzealous pharmacist has raised a red flag and pointed to him/her. Furthermore, whether real or imagined, the pharmacy is also responsible (albeit to a lesser extent) for every prescription it dispenses, including DUR (drug utilization review), the failure of having done so in light of a serious problem (overdose, contraindication, diversion) puts their licenses and livelihoods at risk, including potential civil and criminal penalties as well. In addition to revenue-sharing agreements, the understanding that a pharmacist will not question a prescriber's prescription or prescribing habits such an important and prevailant characteristic of virtually every OP in existence, and the reason they us a fixed set of pharmacies.

From a therapeutic perspective, there are MANY valid reasons for a physician to NOT reach for the prescription pad and pen the highest quantity of the strongest narcotic that may pass without scrutiny. First of all, the presence of SOME pain can be an EXTREMELY valuable signal to a potential or progressing problem. Many patients have used opiates and their derivatives as a means of supressing symptoms without ever treating or perhaps even truly identifying an underlying disease, which in the extreme, could have been relatively benign and treatable at its onset, but progress to being extremely serious, perhaps beyond the point of being treatable or life-threatening (such as an infection becoming septic, when the pain medication may mask the pain symptom AND the non-narcotic analgesic may supress tell-tale fevers). I certainly would NOT want that on MY conscience whether or not I could later rationalize it by having simply given a patient what he or she requested at the time. Second, there is much validity to the theory that the MOST appropriate medication is the LEAST strongest which will provide relief, which may or may NOT be a narcotic or the particular medication to which one is accustomed to receiving. Third, with every narcotic medication, abuse, dependence, and worst of all, addiction potential exists. While dependence may be medically perfectly appropriate during long-term treatment, addiction may not be; and in cases when there may have been an alternative, the prescriber can be civily and criminally responsible according to the law, not to mention one of the first precepts of the Hipocratic Oath, which is that doctors shall "do no harm". (Note: it is important to understand the fundamental differences between tolerance, dependance, and addiction.)

Yes, as a whole, chronic pain patients are woefully undertreated and there is both a VAST general lack of understanding and terrible fear among the medical community, by both physicians and pharmacists, of what constitutes inappropriate prescibing and the extent to which it may jeopardize the livelihoods for which they may have spent hundreds of thousands of dollars and studied up to 12 years to achieve. While there are some practitioners who suffer from a God complex at their patients' expense, those at such an extreme are by far the exception, although even one is one too many. Furthermore, why would I expect any reasonable consideration on their part for my foremost concerns if I was not at least willing to try to appreciate theirs as well? No patient's license to seek medical treatment was ever lost as a result.

Forgive my diatribe, but expressing disdain at anything less than on-demand availability of powerful narcotics actually takes us farther away from a solution as it invites scrutiny (read law enforcement), cheapens a valid argument, and perhaps most of all, alienates those whose support we must have. If it sounds preachy, I didn't mean to, but the lack of consideration in the original question made it diffult to avoid. It demonstrates the self-same problem that makes such necessary medications so difficult or impossible to obtain, which is either ignorance of or a lack of appreciation to that which may be most important to another and which matters most when the two happen to conflict. In fact, it is the patient's responsibility to ensure that the prescriber is as well-informed as possible about his or her condition, as this is one of the cornerstones of seeking health care, which one must also assume is the real puprose of treatment, otherwise it is difficult to distinguish from simple drug seeking. I'm afraid that little will be accomplished with any measure of security as long as the primary focus remains "I should" and "I want" instead of "these are the reasons I should" and "this is the basis for my need".

To wit, I applaud the telemedecine providers and progressive medical community who strive, often at great personal risk (for which they are entitled to the substantial potential reward) for making difficult and powerful medications safely and more accessible. I believe they fulfill an absolutely critical need in today's society for which there is a terrible void that comes at the expense of those who must live with constant and/or intractible pain. Any moment an individual endures unecessary pain is an abomination, but the patient has to accept more responsibility than a simple and inviolate expectation of doctors being souces for prescriptions instead of health care, of which prescriptions, pain medications, and relief are all parts.

Just my $.02.