ibsen120414_C This is the transcript of Dr. Mark Ibsen’s inquisition by the attorney of the MT Medical Board.. all 600 + pages .. it was hard keeping from YAWNING while reading… Feel free to knock yourself out and read it all…
This Pharmacist stated that she has been licensed for 28 yrs and has some training and experience in chronic pain but apparently the majority of it is in the acute setting…
To put things into perspective… it is like saying that while I can water ski fairly well … I would not be bold enough to think that I could take those skill sets and start snow skiing with the same level of proficiency …
Apparently this Pharmacist has not be a Pharmacist long enough to remember all the Darvon Comp 65, ASA Comp w Cod, Tylenol w Cod that was prescribed back in the 70’s-80’s as well as all the Darvocet N 100 prescribed after Darvon Comp 65 lost it patent…
I worked for a Independent Pharmacist owner in the late 60’s who was all crippled up with arthritis and he “ate” Indocin caps trying to manage his pain… but.. you could see the cringing on his face as he waddled as he walked…
I love the quote that we take 95% of the Hydrocodone production… which is true .. HOWEVER… the rest of the world uses Dihydrocodeine to treat pain.. It is a weaker opiate than Hydrocodone. We have/had a product called Synalgos DC that contains Dihydrocodeine… but very little is prescribed.
I worked with another person in the early 70’s that had severe arthritis.. she worked the cosmetic counter at the store that I worked at.. See took so much Aspirin that she was always complaining about the ringing in her ears. Classic for taking TOO MUCH aspirin..
Today it is recommended that seniors should not take NSAIDS (Aspirin, Motrin) because of gastric bleeds, should not take Tylenol/Acetaminophen because of liver damage… and can’t take Prednisone/Cortisone long term because of bad side effects and now they want to take away opiates for the fear of potential addiction.. The options for treating chronic pain.. are diminishing ….
Q.
Let’s talk about the present history of
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1 pain management and chronic pain management in the
2 United States. Let’s say 25 years ago or so, what
3 were the common applications of chronic pain
4 treatment, what diseases?
5 A. The pain management really has changed.
6 In the like late ’80s, in the ’80s, chronic pain was
7 considered cancer pain and that was — you treated
8 cancer pain, but we didn’t have a lot of this
9 chronic pain like we do now.
10 There really became a shift in medical
11 practice and thinking where pain — there was a much
12more heightened awareness of pain, treating pain.
13Pain became the vital sign. Regulatory and
14 accreditation agencies were, you know, advocating
15 for patients and surveying health systems for
16 appropriate pain management and recognizing pain.
17 Pain is what the patient says it is. So really,
18 there really was this big shift of the pendulum
19 from, you know, pain and pain medicines being
20 reserved for either acute instances or in a chronic
21 case just for like cancer pain, and that really has
22 shifted.
23 Q. What did that do to the number of
24 prescriptions for opioids?
25 A. It increased it tremendously.
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1 Q.You mentioned the pendulum swinging. Has
2 that reversed?
3 A. It is. The pendulum is moving the other
4 way in that thought leaders in chronic pain
5 management, and there is evidence in the literature
6 to show that chronic opioids are really not that
7 effective for pain.
8 Q. Were there other worries besides the
9 efficacy that drove that shift?
10 A. Sure. There have been studies done as
11 recently as 2011 showing that people who are on
12 chronic pain management have higher rates of
13 depression, less activity, they’re less productive,
14 they’re not working when matched with controls. So
15 it really begs the question about the efficacy of
16 opioids for chronic pain in many cases.
17 Q. Were there also societal repercussions?
18 A. Sure. There are societal repercussions
19 with overdoses and lost productivity, increase in
20 costs of health care for recovery and
21 rehabilitation. It is a very big price tag.
22 Q. Are you familiar with statistics on
23 American’s use of opioids versus the rest of the
24 world?
25 A. I am. Well, I think that in the United
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1 States we have 18 percent of the world’s population,
2 but we use 95 percent of the Hydrocone manufactured
3 in the world and we in the United States use 75
4 percent of all opioids used in the world
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