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Dealing Prescription Drugs

Pill

Drug abuse has existed since the dawn of time (or at least since the first person ground a leaf into powder.) Just about any substance can be misused or abused. Many drugs lend themselves to misuse/abuse due to their mood altering effects. However in recent years antibiotics have become misused as well. As a culture we are not entirely comfortable with discussing prescription or over-the-counter (OTC) drug abuse. We know what drug abusers (a.k.a. junkies) look like; we’ve seen them in movies and magazine features. Surely the (pill taking) carpooling mom next door can’t be abusing drugs; look at her! Those honor students doing homework in the media room can’t be abusing A.D.H.D. medication; look at how well they’re doing! What adds a heavy opaque veil to the detection is that these drugs come from doctors. Doctors know a thing or two about the human body and what is good for us, no? In theory, yes.

Detecting drug abuse during a 3-5 minute office visit is not easy. There are those who live with people day in and day out and still have no knowledge of drug misuse/abuse. This is by no means to suggest that doctors shouldn’t prevent and detect misuse/abuse. Quite the contrary. We need to incentivize the doctors to limit prescription writing (kind of the way drug companies give incentives to write the prescriptions.) Primary doctors need to spend time asking pointed and probing questions and not merely relying upon questionnaires to make diagnoses for mood altering drugs. Doctors must know the signs of dependency and always err on the side of lower dosage. Doctors know the signs of mental illness and should be on alert for signs of self-medicating behavior. Doctors should refer patients to a mental health practitioner if there are any doubts about stability. The mental health practitioner and referring doctor must decide in concert what medication (if any) is best for the patient.

Pharmacies are already set up to detect prescription abuse. But there are gaps and it’s not considered abuse to fill legitimate prescriptions. We need to start with source (or ‘dealer’ as he/she is known on the street.) Doctors are not looking to get people ‘hooked’, not consciously anyway. For the most part they want their patients to be healthy and happy. They certainly don’t want to see their patients in pain, physical or psychic. Pain medication is tricky business and that’s why there are specialists and pain clinics. Managing pain and pain amelioration can’t happen in a 3-5 minute general practitioner’s office visit. General practice is not the place for treating a cognitive, behavioral or mood issue either. Psychologists and psychiatrists are trained to diagnose learning disorders, and behavior and mood disorders. Relying on general practitioners to treat all aspects of the human condition is quaint and ridiculously. No one person can possibly be up to date on all the medical developments of the 21st century.

We’ve become rather blasé about medicine; ironically as it’s become space age in its sophistication. But we are wrong to do so. Often times, dangerously wrong. Drugs are drugs; whether they come in a childproof bottle or a tiny ziploc bag. They can be life saving or ending, and should be treated as such.

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Posted by on February 3, 2013 in Cultural Critique, Well-Being

 

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A Health Care Reformation Proclamation

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Medical Insurance (or as it’s less accurately known; health insurance) is on its way to reformation. It’s not clear if the results of the reform will render the; coverage, procedures and rights of the users any more decipherable than they are right now. But what is clear is that the more something is examined the more flaws are brought to light.

We can all probably agree that good medical care should be available to all. Whether insurance is the means to that end is highly questionable. But we seem to be stuck with that particular paradigm. Anyone who has ever sought treatment, payment or reimbursement would probably be happy to swear on a big towering stack of bibles that insurance companies seem to be in the business of making money not providing good healthcare. But as we established; we are stuck with this paradigm. In the interest of making lemonade out of the soul crushing demoralizing oligarchy of the paradigm, let’s consider how government involvement might improve things. (There will be no rolling of the eyes.)

The most obvious improvement will be filling gaps in the current usage of medical care. Insured people are presumably less likely to use emergency rooms as their general practitioner. This is good for both continuity of care and preventive efforts. It is also an enormous cost savings. Insured people are more likely to visit doctors before a condition become acute. They are also more likely to take the full dosage of their prescribed (co-pay) medicines, when not compelled to ration. In theory medical insurance for all will lead to medical care for all. Whether it’s ‘good’ medical care is another issue altogether (that was less of an eye roll and more of a ‘whatever’.)

Where things potentially get exciting and sane is the possibility of payment parity. Currently medical insurance is sold in two sizes; individual and family. The individual plan is discreet and self-explanatory. The family-size is an unlimited free for all. There is nothing equitable about this framework. A two-person family is paying the same rate as a ten person family. A parent with one child is in essence subsidizing larger families. Two options of coverage (individual and family) only benefits large families (and no doubt insurance companies.) There is no other insurance plan (of which I’m aware) that operates this way. You don’t buy homeowner insurance for either one home or an unlimited amount of homes. You don’t purchase auto or life insurance in this manner either. You purchase insurance plans for each entity that needs coverage.

I would like to think that as the thinkologists are drawing up this new way of doing medical care business, they will take note of this inequity. (Can’t really see my eye rolling behind these rose colored glasses, can you?) Perhaps when all people (not covered by employers) have to purchase insurance they will balk at the two sizes fits all framework. People probably don’t spend a lot of time scrutinizing each pay-stub and considering their pre-tax contributions. But it’s hard to ignore being overcharged when you are writing the check.

Sometime during the last four decades or so we’ve convinced ourselves that medical insurance is mandatory and good. It is not a coincidence that healthcare costs have skyrocketed as we succumbed to this thinking. There are too many bad medical practices and less than good doctors hiding behind insurance. There is far too much money and time spent trying to keep costs down versus caring for people. Good care that focuses on what’s best for the patient is what we need. We’re on our way to medical insurance for all. Now how about some actual health care reform?

 
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Posted by on January 31, 2013 in Cultural Critique

 

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