Pain Doctor Faces 20 Years to Life for Trusting Patients

Speaking of piling on federal charges, a jury yesterday convicted Kansas pain doctor Steven Schneider and his wife, Linda, who worked as a nurse in his office, on five counts of illegally writing prescriptions, 11 counts of health care fraud, and 17 counts of money laundering. They face sentences between 20 years and life. All the charges stem from the claim that Schneider was operating a "pill mill" disguised as a medical practice, prescribing painkillers for patients who did not have a legitimate need for them. Prosecutors also tried to implicate Schneider in 68 patient deaths, including patients who committed suicide, patients who ignored dosage instructions, patients who used illegal drugs along with painkillers, and patients who died months after seeing Schneider or while he and his wife were behind bars.

I have not examined the evidence in the case, so I cannot say to what extent Schneider was duped by patients or whether he was negligent. But judging from the press coverage, the case looks much like others in which conscientious doctors have been treated like criminals because they put the interests of their patients ahead of their role as conscripted soldiers in the war on drugs. The prosecution and the press typically conspire in cases like these to present every aspect of a doctor's practice in a sinister light. Prescribing painkillers becomes drug trafficking, applying for insurance reimbursement becomes fraud, making bank deposits becomes money laundering, working with people at the office becomes conspiracy, and a patient's death becomes homicide.

The Pain Relief Network's Siobhan Reynolds has championed the Schneiders' cause from the beginning, prompting a vindictive investigation for obstruction of justice because she publicly disputed the prosecution's portrayal of the couple. "The crisis in pain treatment is going to deepen even further," Reynolds said outside the courtroom yesterday. "People are going to have trouble getting care because doctors are afraid this is going to happen to them."

[via the Drug War Chronicle]

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  • ¢||

    You're fucking up the Conway For Senate post down there. Is there no LINOlist?

  • jj||

    We are taught in med school that pain is completely subjective. ("When the patient says he/she is in pain, they are in pain, and should be treated likewise.")

    So my question is, if medical science cannot identify the fakers vs the sufferers, how in hell can the government? This is a travesty.

  • ||

    Because the government doesn't give a flying fuck about human beings, media fairytales notwithstanding. The government isn't seeking the truth; it's seeking "criminals" in order to "prove" that we need the government's protection.

  • ||

    I don't know how you can say it's "completely" subjective. For example, doesn't a person in pain tend to have higher blood pressure?

    Also, someone who is already under treatment by a pain doctor and says their pain is getting worse may be only developing tolerance to the prescribed meds.

    That said, the charges sound like another witch hunt.

  • jj||

    No. There are indications that a person is under stress, but there is no way of telling the amount of pain a person is suffering. You can be in pain and have hypotension, hypertension, or no blood pressure changes. Pain is a completely subjective experience.

  • jj||

    We know based on studies that pain genuinely exists. People sharing a disease share similar pain experiences. We diagnose pain using a pain scale question ("On a scale of 1 to 10, what is your level of pain.") Even this is pretty much meaningless: one sufferer's 2 could be another's 10.

  • ||

    So is the VAS or equivalent used to establish a baseline in patients to determine whether a treatment is helping?

  • ||

    Yes. The Numeric PX scale (or Wong-Baker face scale, if useful or appropriate) should be part of every VS interaction with a patient. What must be kept in mind here is pain is very individual to the patient. Like jj said, for some people a pain scale of "5" for them may be tolerable and they can complete ADL without much problem. Others may say "2" and they think they are in absolute agony. This is where establishment of the pain scale baseline is critical.

  • ||

    Where's the nerve induction box from Dune?

  • ||

    I have one in my office, of the Dune kind, for non-compliant patients. Juanita would be a good choice.

    I have a wonderful woman who sets the standard of nerve induction with her box, but that is for me only. ;-)

  • ||

    I don't know how you can say it's "completely" subjective. For example, doesn't a person in pain tend to have higher blood pressure?

    No sage. Elevated BP is a response to trauma or fluid imbalance, and should not be used to DX, confirm, or r/o pain. There are different types of pain and pain receptors as well. I specifically tell med students, nursing students and nurses not to use VS as a pain quantifier or qualifier. Patients experiencing chronic neuropathy, for example, with labs WNL, should have elevated BP, yet don't, absent an underlying condition. jj is correct: pain is what the patient tells you, simply put. This case makes me sick, absolutely ill. I feel like losing my lunch.

    Also, someone who is already under treatment by a pain doctor and says their pain is getting worse may be only developing tolerance to the prescribed meds.

    Correct. Tolerance or the pain threshold limit of a particular drug TX regimen has been reached. Pain is one of the most basic of responses to trauma, yet is still poorly understood.

    That said, the charges sound like another witch hunt.

    Every doctor, including me, fears the DEA, for this very reason.

  • ||

    Some doctors use the MF Test. If the patient screams "Mother Fucker!", then the pain is severe enough to justify prescribing a week in an opium den.

  • ||

    I keep Bene Gessirits around for you, Pro'L Dib, and they do have the Gom Jabbar.

  • ||

    "You've heard of animals chewing off a leg to escape a trap? There's an animal kind of trick. A human would remain in the trap, endure the pain, feigning death that he might kill the trapper and remove a threat to his kind."

  • ||

    *Sittin in my trap now, just WAITING*

    (DONT FUCKERS EVER COME BACK TO CHECK THEIR TRAPS?! or is that not "progressive"?)

  • EMS Guy||

    GM, thanks for your commentary on this. At my level of certification we don't get much face time with MDs.

    I come here for the political commentary and end up learning stuff.

  • ||

    I started coming here to learn proper argumentation. It was the only place on the web i say any of it.

    And y'all keep the flame burning, despite Maxchonywardrriss's best attempts to divert that fire.

  • ||

    * i saw any of it

  • ||

    In addition to this, there are changes to the nerves involved in pain over time. The body will most likely no longer show the physical arousal in cases of chronic pain.

    There are also studies that show that some people's tolerance for pain declines over time in chronic pain conditions--essentially, over time, pain hurts more. Doctors (myself included) are left to guess whether the patient's pain is real, whether the intensity is what the patient reports it to be (I almost typed "Claims to be"--see what this does to you?), and make decisions accordingly.

    Some doctors see addicts in every patient and simply don't prescribe opiates, but have the advantage of rarely running into the DEA because of their prescribing practices.

  • ||

    The body will most likely no longer show the physical arousal in cases of chronic pain.

    Good. Two Birds with One Stone.

  • Abdul||

    Every doc soon encounters addicts who attempt to manipulate soft-hearted docs for unneccsary pills. My wife had a story about an obese patient who told her he needed growth hormone. Why would a big guy need growth hormone? High re-sell value to body builders.

    It's no shame to get sucked into the drama a few times, but if one regularly falls for it, you're not really practicing medicine.

  • jj||

    Have you been to a pain clinic? Every single patient every minute of every day is claiming to be in huge amounts of pain. NONE of it is verifiable. What is a pain doctor to do?

    There is only so much "people" reading you can do. If someone appears suspicious, do you deny them med as a drug seeker?

    My girlfriend, a severe migraine sufferer, with a history of family strokes was turned away from an ER (with what appeared to be the symptoms of a TIA stroke) by a resident doctor who didn't bother to do a decent H&P because he thought she fitted the "profile." If anything had happened to her, I would have personally sued.

  • ||

    Have you been to a pain clinic? Every single patient every minute of every day is claiming to be in huge amounts of pain.

    Not true. Many are returning to touch base regarding their pain management program. It may be as simple as making sure their treatment is adequate. The doc may spring a piss test on them to make sure they arent' diverting or using other stuff. They may be coming in to get trigger point or epidural steroid injections before their chronic pain gets out of hand.

    NONE of it is verifiable.

    As you and Dr G above specified, this part I will agree with.

  • The Gobbler||

    "Have you been to a pain clinic? Every single patient every minute of every day is claiming to be in huge amounts of pain. NONE of it is verifiable. What is a pain doctor to do?"

    Make them do push-ups. Tell them, if you are truly in pain, you will prove it by doing 200 push-ups in less than three minutes. If they clear that hurdle, they get unlimited access to morphine.

  • jj||

    In other news: Weigel resigns from WaPo for insulting Drudge.

    http://news.google.com/news/mo.....mp;topic=h

  • ||

    Keep posting it. Maybe reason will have a comment some time soon.

  • smz||

    Sounds like a perfect late Friday post dumping.

  • Robert||

    So why do juries see these things so differently? Can you see any better way of making these determinations than a jury trial?

  • Ska||

    That's what I want to know as well. Who votes to convict on this type of shit?

  • ||

    The vast majority of average people that are scared of something they don't really understand because they buy into Drug Czar hype and the demonic portrait of doctors, by statistic prosecutors?

    I think you might want to ask a better question, like: "Why are people so fucking stupid?" Unfortunately there is no real satisfying answer.

  • ||

    Statist* Stupid auto correct.

  • Robert||

    Most people aren't stupid, or the word would cease to have meaning -- or at least that meaning. Maybe the problem is not that most people are stupid, but that some people (say, commenters here) are naive.

    Everyone knows doctors and therefore has some familiarity with the practice of medicine. Pain specialists are still in business. So what does it take to convince juries that certain doctors abuse their privileges?

    It would seem there are just two possibilities. One is that certain doctors really do stand out in a negative way that is avoidable without sacrificing quality of care. The other is that it's just prosecutor roulette.

    If it is prosecutor roulette, are they so naive as to not realize they may jeopardize their own ability to get pain rx? Or are they not naive, and actually judicious in their choice of cases?

    I just can't believe that doctors, prosecutors, and jurors are all fucking stupid.

  • newt||

    Women. They make great jurists b/c they love when big strong John Law protects them from the bad guys.

    Also, I would think your general runofthemill evangelical would make a superb jurist in a drug-related trial.

    Statists and stupid people also make exceptional jurists.

  • ||

    *note to self: become a Big John Law type. then i can fuck all the stupid bitches i want.....wait, they stupid? I CAN FUCK THEM NOW, WTF?!?!?!*

  • ||

    Is removing MDs as gatekeepers for pain medication too fucking obvious?

  • ||

    And if an opiate naive patient is allergic to the pain medication and no one is around to administer epinephrine?

  • ||

    I don't hear them, cause i'm not in their forest?

  • BakedPenguin||

    Wouldn't this only be a problem if the medication was morphine? Or do other opiates cause hystamine cascades?

  • ||

    If one demonstrates a hypersensitivity to Morphine SO4, then they are literally in a world of hurt as other opiates will cause a histamine cascade, and immediate admin of both Narcan and an antihistamine (like benadryl) is ordered stat, as well as epinephrine for anaphylaxis.

    Pruritis (itching) is the most common side effect of MSO4 TX and is not a opiate allergy.

  • ||

    Well that's good to know, because I've developed a pruritic response to the codones.

    So, does this mean straight up morphine will do it to me, too?

  • ||

    Most likely. The advent of PCA pumps lessens this, as patients get the amount that they need to relieve PX. Benadryl is most often prescribed for the itching.

  • ||

    (feel free to answer by e-mail to avoid a threadjack)

    Do you know why drugs like benedryl and phenergan (and others) cause akathisia?

  • ||

    The exact mechanism is unknown, but the current school of thought is the action of beta-adrenergic synaptic receptor sites, leading to the S/S of akathesia, and to lesser extent, tardive dyskinesia.

  • ||

    Has to do with their effects on dopamine receptors in the movement centers of the brain.

  • BakedPenguin||

    Thanks for the response. Also, sorry to ask a shop question out-of-office (I know docs get that a lot), but I thought it was an important point to clarify.

  • ||

    It's an excellent question BP; it's important because those who think they are allergic to morphine and other opiates/oids, and in reality they don't, have greatly limited the pain and anesthetic options they have, as they won't be given due to contraindication and greatly complicate both pain management and surgery, not to mention routine care. Allergies are taken with the utmost seriousness. Again, if you don't have urticaria (hives) and edema, either localized or systemic, then you ain't allergic.

  • ||

    Also, sorry to ask a shop question out-of-office (I know docs get that a lot)

    It's not like you whipped him till he fiex you elbow. Though to Groovus's credit, he didnt even force me to whip him to get some free medical advice. I had the whip ready and everything, and he was all "dude, its easy, stop spanking it so much", and my elbow is better.

    I still got the whip Groovus, can I trade that for the pay-pal bill i keep dodging?

  • ||

    Groovus-

    So what? Live free...

  • ||

    Hell, a non-naive patient could develop an allergy (*raises hand*) and still be screwed.

    Unless said patient (*raises hand*) already has an epipen on-hand after discovering a simultaneous new allergy to legumes and casein.

    O_o

    AAAAND none of this takes into account the possibility of genetic variation. Patients who are homozygous for a variant in OPRM1 require much higher opioid dosages than those who are homozygous wild-type - it's a very nice gene-dose response curve, actually.

    So patients who get their two hydrocodone pills and still complain of pain may be telling the truth.

  • ||

    The interest I have in that Dr. Bronwyn, for OPRM1, is both possible prediction of tolerance curves and dependency of opiates/oids, and for drug forms that allow prescribing dose by weight in adults would allow for better drug efficacy with lower adverse effect occurances and allow for more effective chronic pain TX.

  • ||

    If you ever wanted to do a study or decided you wanted to order tests, I can help with that. (clicky for Dr. Bronwyn's Official E-Mail Address)

  • ||

    discovering a simultaneous new allergy to legumes and casein.

    My condolences.

  • ||

    It's been rough. For some reason, broad beans are ok. And milk of all fat content levels is bad news, but yogurt is ok. And we're talking about hives and anaphylaxis ... makes no sense to me. I wish I knew a food chemist who could explain it to me.

    I did find that refried speckled butter beans are just as good as traditional refrieds. That's one dietary crisis averted.

    My husband suggested the bean allergy could be grounds for divorce, so I thought it important to try to find substitutes.

  • BakedPenguin||

    Just a guess, but with the milk, perhaps the bacteria breaks down the offending allergen in yogurt - and that it doesn't occur in milk.

    I have a minor allergy to tomatoes. If I eat them fresh, I get hives, some gastro problems, etc. If I eat processed tomatoes (pizza sauce, spaghetti sauce), this doesn't happen. I suspect there is something in the processing that breaks down much of whatever the allergen is.

  • ||

    I did find that refried speckled butter beans are just as good as traditional refrieds.

    Honey, you can re-fry/double-cook just about ANY bean, and it tastes better too.

    Getting them to not stick to the pan can be troublesome...there might be an Alton Brownism to fix that though.

  • ||

    :)

    Now to see if the same can be said of baked beans...

  • ||

    Uh-oh.......baked?

  • ||

    And if an opiate naive patient is allergic to the pain medication and no one is around to administer epinephrine?

    Then they would be in trouble. Like anything, you would have to balance that against all the people that you would condemn to suffer (or to spend extra money) because of their difficulty in getting medication.

    You have the same "just looking out for your best interests(tm)" attitude as the DEA and "current med school dogma" that you decry. You just trust your own judgment and your right to be the gatekeeper, but don't trust the DEA or current med schools.

  • ||

    And if an opiate naive patient is allergic to the pain medication and no one is around to administer epinephrine?

    So I assume, Groovus, that you're in favor of making aspirin prescription-only to prevent Reve's syndrome, and making Tylenol prescription only because of liver damage?

  • ||

    No. You assume incorrectly JT. Those drugs are not scheduled, as you well know. I do know pharmacists and other doctors who wouldn't mind seeing Tylenol script not only because of the liver damage it causes, but also because of the suicide attempts associated with it.

    That aside, the risk of Reye's Syn is fairly remote unless taken when varicella zoster is present.

    I get your point, but also neither ASA or APAP has the risks of dependence and addiction associated with either. When was the last time the Mexican Mafia sent a drug mule full of ASA or APAP.

  • ||

    When was the last time the Mexican Mafia sent a drug mule full of ASA or APAP.

    When they hired a dude who was already on that scription?

  • ||

    This sort of prosecution is the obvious result from making doctors gatekeepers. Which itself follows from government paid healthcare

    "People will take unnecessary meds, raising costs!" -> Make doctors gatekeepers
    "People will now just shop around and it will still raise costs!" -> Convict doctors who don't do it the approved way.

    Health insurance companies might like to stop doctors, but they can't throw them in jail.

  • ||

    Interesting Thacker. Who is going to absorb the liability for the prescription and dispensing of said medications? Pharmacists (no prescriptive authority)? ARNPs (who have limited prescriptive authority)? Big Pharma?

    In a libertopia, it would be the patient, of course. In our litigious society, people want an authoritah to which doctors are accountable. The State Board is one and Health insurance companies, the other, have us by the nuts and ovaries more than you think.

  • ||

    Man, i wish poeple would stop suing state boards for fucking shit up...huh? No one ever goes after the board, because the productive member of society has more skrimps for me to has?!?!

    WHERES MY SKRIMPS!!!!!!

  • Hermaphrodite?||

    "have us by the nuts and ovaries more than you think."
    Your girlfriend must have an interesting box!

  • ||

    LOL thanks for pointing out my grammatical error.

    "Your girlfriend must have an interesting box!"

    It's quite heavenly; She's Canadian :-)

  • Lol||

    Canadians believe in universal health care

  • ||

    Maybe so, but we agree to disagree on the subject. ;-)

  • ||

    Dinner conversation in the Groovus household involves a lot of disagreement...which makes for lots of good make-up sex.

    DAMN YOU G!

  • ||

    check your email G-man!

  • ||

    Who is going to absorb the liability for the prescription and dispensing of said medications?... In our litigious society, people want an authoritah to which doctors are accountable.

    Blaming it on being "litigious" is a red herring. So long as you doctors insist on maintaining your legal privileges as gatekeepers, you're going to end up taking responsibility for it. If it wouldn't be lawsuits, it would be government regulations like it is in other countries. Of course, tracing all that down to who eventually pays for it is complicated.

    Health insurance companies, the other, have us by the nuts and ovaries more than you think.

    No shit, because they pay for things. You can't expect someone to pay for something and not eventually exercise enormous power of it, whether private or a governmental body.

  • ||

    Of course, tracing all that down to who eventually pays for it is complicated.

    I pay for it, despite have not been to a doctor in over 5years. Not THAT complicated. And, no, I'm not talking about insurance premiums...like any insurance company would cover a guy who drinks, smokes, and plays with high-voltage....c'mon.

  • ||

    Blaming it on being "litigious" is a red herring. So long as you doctors insist on maintaining your legal privileges as gatekeepers, you're going to end up taking responsibility for it. If it wouldn't be lawsuits, it would be government regulations like it is in other countries. Of course, tracing all that down to who eventually pays for it is complicated.

    I am not unsympathetic to this JT. Truly, if I could just hang a shingle and do what I do, great. However, since the human body and life is irreplaceable, the degree of liability goes up. I don't agree with gatekeeping per se, but on the flip side, the licensing scheme is what it is, and my one pointless dissenting opinion against it isn't going to change things much. As a libertarian, if you want to buy whatever drug you want, use WedMD to self-DX, and use a sewing kit for your surgery, fine by me; I'll be glad to fix your mistakes. Or you want to go to a naturopath, homeopath, Eastern medicine practioner, ARNP or PA, fine by me. It's your body. As a physician, I'm stuck in the the licensing scheme, and as this article demonstrates, even following the rules (assuming this Dr. and his nurse did) can lead to tragedy if you piss off the wrong people re: The DEA.

  • ||

    Yeah, it's a crappy position to be in, and I understand that one person can't really change the system.

    I personally trust the medical establishment, and prefer to get medical advice from doctors rather than self-diagnose. But as a libertarian, I realize that certification and licensing schemes quickly become monopolies that carry a heavier burden than people realize.

    I'm just more upset at the people who willingly invite(d) the government in to enforce their privileges, and then act all shocked when government turns around on them.

  • ||

    Robert, most juries are composed of morons and the prosecutors (and defense) like it that way. Typical juror is either retired, on welfare/disability, or otherwise doesn't have anything better to do. Most productive people tend to avoid jury duty by any means necessary.

    I was struck for asking for the "non-religious version of the oath." Pissed the judge off, and good.

  • ||

    When I have been called, I have gone. I have only served on one jury. It was a contract case between two businesses along with a statutory consumer protection claim. (Massachusetts permits one business to sue another under the statute-M.G. L. ch. 93A).

    Three or four other times I was not selected. I want to serve on a jury in a case where I can nullify.

  • ||

    Huh. That's interesting. If I ever have the chance to be in the situation, I'll let you know if the same thing happens to me.

  • Robert||

    The jury selection process doesn't explain anything. Being retired, on welfare or disability, or not having better things to do doesn't seem to have anything to do with judging whether a doctor's practices are sincere. If anything, it would seem that people in some of those categories have more than avg. contact (and therefore familiarity) with doctors.

  • Dello||

    I wonder if Obamacare will make this better...or worse, for both doctors and patients.

  • Sudden||

    Under Obamacare you won't need pain meds because you will never feel any pain and if you did feel pain it would be treated with rainbow-colored vomit from unicorns.

  • ||

    "Keep honking, I'm relaoding my gun" seems the most appropriate response to that sort of Bullshitspewing.

  • ||

    Internet toughguy aside, i would KILL a fucking doctor if he told me to buck up and think about rainbows when i NEED ral painkillers.

    "Ok, got all those wisdom teeth out. Now: Red, Orange, Yellow, Green, Blue, Indigo, Violet."

    "EXCUSE ME....oh sorry did i stab you in the eye before i even asked the question? My bad."

  • BakedPenguin||

    My brother ocassionally gets a bad case of bursitis. It wakes him from sleep, and makes it hard for him to even drive. His doctor would only give him APAP for that. He wound up taking benzos with alcohol so he could get some sleep.

    When I heard about this, and thought about the risk he had to take because of the fucking moronic drug war, it really made me hope the headquarters of the DEA is filled with radon.

  • ||

    Internet toughguy aside, i would KILL a fucking doctor if he told me to buck up and think about rainbows when i NEED ral painkillers.

    Thanks to current med school dogma about opiates/oids, expect this attitude to be more prevalent from physicians. But, remember, the DEA "is just looking out for your best interests(tm)".

    When I heard about this, and thought about the risk he had to take because of the fucking moronic drug war, it really made me hope the headquarters of the DEA is filled with radon.

    You are not the only one to share this opinion, FriedAquaticAvian.

  • ||

    But, remember, the DEA "is just looking out for your best interests(tm)".

    News at 11: Eye-Stabbings up 7600%.

  • ||

    Thanks to current med school dogma about opiates/oids, expect this attitude to be more prevalent from physicians. But, remember, the DEA "is just looking out for your best interests(tm)".

    I'm sure that's what they think, just like plenty of doctors convince themselves that it's all for the greater good that they have a legal monopoly controlling access to the drugs too.

  • ||

    it really made me hope the headquarters of the DEA is filled with radon.

    You are not the only one to share this opinion, FriedAquaticAvian.

    Radon isn't slow enough. I want them to get a Police Horse to accidentally step on their foot, so they have an inoperable pain-causing malfunction in their foot till they die a nice death at ~100years-old.

    Amateurs.

  • EscapedWestOfTheBigMuddy||

    Internet toughguy aside, i would KILL a fucking doctor if he told me to buck up and think about rainbows when i NEED ral painkillers.

    I once walked out of a doctor's office rather then punch the shiteating grin off his face. That's better than he deserved, but I didn't know if the actual patient was ready for me to burn the bridges yet.

    But I have to wonder: if a patient makes an appointment to discuss taking up their pain management and brings you:

    * Their existing supply of opiates and a letter from their previous prescribing doctor stating when they were last seen, what their prescribed dose is and how many pills they had at that visit
    * A four page summary of their conditions from their previous specialist
    * About 300 pages of comprehensive records stretching back ten years and three pain management physicians (and eight other doctors) in four states.
    * A folder of x-ray films
    * A DVD with MRI files

    Do you

    1. read the summary
    2. look at the films
    3. ask the patient for an outline of their previous treatment
    4. count the pills and compare with the expectation from the prescription
    5. all of the above

    or what actually happened:

    6. none of the above but instead treat them like they're come to the school nurse complaining of a headache?

    True story.

  • ||

    *back to my All-Kinks-All-Day marathon....I'm gettin too worked up, and in all the wrong ways. I Cants evens types no mores!

  • Abdul||

    I RTFA's, but no mention of what type of doc Schneider was. 68 patient deaths seems kind of high for say, a general practioner. Maybe it's par for the course for an oncologist or a gerontologist.

  • ||

    Was he forcing people to swallow massive amounts of opiates and mix them with other narcotics at gun point?

  • ||

    Sullum says he's a pain doctor. I would take this to mean "Chronic Pain Specialist."

  • ||

    I would take this to mean "Chronic Pain Specialist."

    so, "drug dealer"?

    (Look, STFU, I'm at least 2x more better at this than Juanita ever was, PLUS I have citizenship papers, BITCH!)

  • ||

    More than once, Reason's articles about Dr. Schneider have pointed out the absurdity of the claim of "68 patient deaths".

  • ||

    Abdul, even medical demigods like GM have a 100% patient death rate. Of course, sometimes the doc dies first, but still... (grin)

  • ||

    So you sue his kids, no prob.

    (wait, what?!)

  • ||

    I have no little GM or GM-ettes to sue wylie. And Tonio is correct: everyone does die at some point, AKA The End. It's the WHEN and HOW that concerns me the most, present company included.

  • ||

    GM-

    You guys do have it rough on this score. Nothwithstanding my disdain for the allopathic school of medicine, I just seethe when reading of the travails of this doc and so many others who have had their lives ruined.

    You strike me as the type of MD in whom I could place my trust. Believe me, there aren't many.

  • ||

    present company included

    See, Groovus cares even though i try my hardest to troll his ass off. What a Champ :-)

  • ||

    Dude thats the craziest thing I ever heard.

    www.Ultimate-anonymity.com

  • Warty||

    Why would anyone become a pain specialist? It's just painting a big fucking bullseye on your back.

  • jj||

    Sadly, I agree.

  • ||

    Yup.

  • ||

    Because Warty, they care. Simply put. As I posted upthread, pain is the one common denominator every human, even every organism with a complex nervous system shares. We understand the mechanical and chemical aspects of pain, but treating it is a real challenge, as every etiology and patient is different.

    Most pain management specialists are anesthesiologists, doctors who make it their life's work to relief suffering and understand the histology, neurology, and biochemistry of relieving feeling. Anesthesiology literally means the "the study of the absence of feeling or sensitivity".

  • Warty||

    Oh, I understand why they do it. It's terrible to see someone suffer. But apparently, helping them is not a terribly smart thing to do in this day and age.

  • ||

    You really need to have good documentation. Many times a patient returns to a pain doctor not because they want to, but because the doctor says they must.

    If I was prescribing you methadone or Oxycontin I'd want to see you in the office once in a while too.

  • ||

    Precisely. It is not a racket, despite what some you may proclaim; any doctor (or any other provider who has prescriptive authority) is both legally and ethically bound and responsible for any medication he or she prescribes. It's your health and my liability on the line here, even if you as the patient choose to sever that relationship.

  • ||

    I've seen many cases where patients test positive for opioids as expected, but also other stuff - cocaine comes up a lot. A good pain doctor will not tolerate that.

    There are also those that "lose" their pills, or they're "stolen" or for some other reason they need early refills. Also a red flag.

  • ||

    True. That, IMO, is responsible medicine. The PX specialist will ask why the other stuff in a piss test is "hot", and may be an indicator that current TX regimen may not be effective or could be indicative of a drug seeker. That is a tough call, but generally, yes, the PX specialist is going to be not happy with that situation; again, liability.

    There are also those that "lose" their pills, or they're "stolen" or for some other reason they need early refills. Also a red flag.

    Drug seekers generally either "doctor shop" or, most commonly, are ER "frequent flyers". ER's keep records of Pain RX written for this very reason. Which sucks for drug seekers if they are in real pain, as opposed to procuring a fix, or more likely, obtaining inventory for selling on the side. It's a risk I view as worth taking so every legit pain case gets treated effectively, just like letting a 1000 guilty persons go free at the risk of incarcerating an innocent one.

  • ||

    Which sucks for drug seekers if they are in real pain, as opposed to procuring a fix

    Is "drug seekers" the right term in that specific case?

  • ||

    The term used is "Pseudoaddiction," when people with legitimate pain problems resort to "addict-like" behaviors to try and access pain meds for undertreated pain. Patients can doctor-shop, buy pills from friends or on the street, steal meds from friends and family. Or resort to alcohol, MJ, meth, etc. Just because people resort to criminalized behavior doesn't mean there is no legitimate pain problem or need for pain meds.

    Another layer to a difficult situation.

  • ||

    The term used is "Pseudoaddiction," when people with legitimate pain problems resort to "addict-like" behaviors to try and access pain meds for undertreated pain.

    True James, that is the proper nomenclature; I don't like it and I feel it mimimalizes, stigmatizes and even demoralizes the one suffering and I choose not to use it. I feel it is a bogus legal term, like "narcotic" and should be banished from the lexicon.

  • ||

    I agree. Narcotic applies to all medications that cause "narcosis" or sleepiness. I, also, think that we need to let people know that diamorphine is just another pain medication criminalized by politicians renaming it to heroin! The term "addiction" is also so misused in society, that it is almost a useless term in identifying the problem drug users.

    Many doctors think that there is a maximum dose (law in some states like Washington) on the use of opiates. Dose must be titrated to effectiveness. Even if it is not according to the PDR!

    I thought I played drug cop real well. But, in the end, licensure is that thing that allows doctors to keep working, right now. And, that is under political control! And, politics can ruin a career. Ron Paul has a lot of influence on my present attitude towards the "war on drugs". It is not what it was before my life was ruined over pain management! But, I was a board certified general surgeon who got training for pain management. (Who would be more familiar with pain?!!) Made no difference in the end!

  • ||

    It's a risk I view as worth taking so every legit pain case gets treated effectively, just like letting a 1000 guilty persons go free at the risk of incarcerating an innocent one.

    But you don't feel like risking one person being an "opiate naive patient [] allergic to the pain medication [with] no one is around to administer epinephrine" in exchange for 1000 getting easier and cheaper access to the drugs, right?

  • ||

    even if you as the patient choose to sever that relationship.

    wtf? Good thing we're going to enslave you Groovus, because it seems a hell of a lot easier for you to be a slave than the rock-and-a-hard place you're in now.

    Just prescribe yourself some ointment for the lashings.

    49 more to go btw, get back on the block.

  • ||

    It is not a racket, despite what some you may proclaim; any doctor (or any other provider who has prescriptive authority) is both legally and ethically bound and responsible for any medication he or she prescribes.

    So long as you have that legal monopoly as the gatekeeper, you had damn well better be legally and ethically responsible, Uncle Ben.

  • objector||

    My psychiatrist does psychopharm and pain med management only. I have to see him every three months for my anti-anxiety meds or I get no more refills. In some ways it's an annoyance, but I know the position he's in. I feel very lucky to have stumbled across such a great psychiatrist in the nightmare world of capitated "behavioral health management" and would lose it if he ever got in the DEA's line of sight.

  • ||

    It might be just me...but i have less confidence in the safety of FDA approved brain-meds than i have in LSD.

  • objector||

    I'm sure it's not just you. But my meds work for me.

  • The Gobbler||

    "Anesthesiology literally means the "the study of the absence of feeling or sensitivity"."

    That's also the meaning of Weigel.

  • smz||

    Who is this Weigel you speak of? I haven't seen any posting about him.

  • Michael Ejercito||

    We understand the mechanical and chemical aspects of pain, but treating it is a real challenge, as every etiology and patient is different.


    What are the barriers to blocking nerve signals that transmit pain?

    Has the nature of nerve signals ever been identified?

  • Jordan||

    Why would anyone become a pain specialist doctor? It's just painting a big fucking bullseye on your back.

    Fixed it for you. Fuck prosecutors, trial lawyers, lawsuit-happy pieces of shit, and Obama.

  • ||

    What more proof do you need that if you legalize poison the violence remains

  • OO======D||

    Prepare for more pain than you can possibly imagine.

  • ||

    You know what "juanita"? Fuck you. Fuck with a rusty chainsaw. I know you're a troll, but it is statist attitudes like this that contribute to shit like this! Where's your compassion for people in so much pain they can't even move with out great effort? People that can't even hug their kids, much less take care of them (or themselves) because the pain is so debilitating? People that would give anything (and some do via amputation) and all sorts of other unpleasant methods to be relieved of their pain.

    If you aren't a troll, then any surgery you have, no anesthesia. Hypnosis only. For YOUR post op pain, APAP. Or better yet, a placebo and a faith healer.

  • ||

    If you aren't a troll,...

    Troll isn't the right word: Parodist, Satirist, etc

    I *heart* Juanita. If there's anyone who's doing more to debunk the bullshit propaganda (by spouting said propaganda), i'd like to see it. So i can laugh. Hard.

  • ||

    Another marijuana-related death!

  • ||

    So if i kill Jaunita, while I'm completely sober, that still counts? Sweet, I'd love to be the 1st "marijuana death" on record.

  • BakedPenguin||

    The prosecution and the press typically conspire in cases like these to present every aspect of a doctor's practice in a sinister light

    On the rare instances where I catch the local TV news and they have a case like this on, I usually wind up wanting to take a pick ax to the spines of the "journalists". Let them suffer horrible pain for years on end, and then see if they can still mount their 'moral' high horses about "pill mill docs".

    Fucking worthless assholes.

  • Sudden||

    Innocence until proven guilty is supposed to be the cornerstone of American jurisprudence.

    Guilt until innocence is proven (and even after in most cases) is the actual cornerstone of American journalism.

  • ||

    Checks and Balances, right? RIGHT? RIGHT??!?!?!??!?!

    (Where's my pickaxe, and where's the localest TV station....)

  • ||

    Ya know, Hit n Run has become an endless series of reasons why I can't move to Panama too soon.

  • ||

    Because Panama is just the 53rd (Unofficial, because then we'd have to give them representation) State?

  • Ivan||

    Panama?

  • Hacha Cha||

    Fuck the government. End the war on pain patients and the doctors who dare to treat them.

  • ||

    Allow me to second HachaCha's "FUCK YOU".

  • EscapedWestOfTheBigMuddy||

    /Too mad to post anything coherent.

    //Trying hard not to wish pain on people.

    ///Wondering if I have to count Jaunita as a person for the purposes of the above.

  • ||

    You're trying too hard.

    Just relax. And wish pain on as many motherfuckers as you can. It's not like wishing ever did anything, and even if it did, that can't pin it on you.

  • ||

    *they can't

  • ||

    Juanita is a parody that intentionally makes the WOD look stupid by literally saying all their talking points.

    Get it.

    ... Mari...juanita...

  • Bob||

    Doctors should probably avoid prescribing addictive drugs for pain. I can't see any doctor being willing to prescribe opiates in lieu of NSAIDs.

  • ||

    I see you are neither a chronic pain patient nor a physician.

  • Bob||

    No I am not an MB, it is just a matter of the risk is too high. This is not a good outcome.

    Obviously NSAIDs are more physically unhealthy, and are totally inappropriate for some kinds of pain. I would think they would not work too well for nerve pain? What else works for pain? Anticonvulsants? Tricyclics?

  • ||

    ALLAH FORBID someone be "addicted to opiates" rather than live in constant pain.

  • ||

    "We can't allow that sort of choice to be made by individuals."

  • EscapedWestOfTheBigMuddy||

    Right, Bob.

    'Cause patients in unrelenting, excruciating pain (and their physicians) haven't spent decades trying every option that comes onto the horizon in search of whatever works best for them.

    Sure.

    That makes you an asshole as well as a nitwit.

    /The pain patient in my life has tried literally scores of combinations of literally dozens of drugs, and more than a dozen types of non-drug therapies. But surely you know better.

  • ||

    That makes you an asshole as well as a nitwit

    Yes. Next question?

  • ||

    I would think they would not work too well for nerve pain? What else works for pain? Anticonvulsants? Tricyclics?

    Neuralgia is diffcult to treat. GABA receptor sensitive drug such Neurotin can be effective, as can other drugs that effect dopamine levels, such as atypical antipsychs, and anti-depessants affecting both serotonin and epineprhine/norpinephrine re-uptake inhibitors. Decadron and other steroid injections/IV can be helpful as well. Properly diagnosing pain is in itself an art.

  • EscapedWestOfTheBigMuddy||

    Neurotin and Lyrica are wonder drugs for some people. Praise be! I've known a couple of people who've been able to take up their real lives again thanks to that stuff.

    'Course in other folks they cause narcolepsy and mental symptoms I like to describe as "senior moments on steroids" to the point that the side effects are at least as disabling as the pain.

  • Hacha Cha||

    Lyrica, SNRIs, and opioids, surprise, like tramadol, tapentadol, methadone, levorphaol, etc., etc. are good for treating nerve pain because they effect the opioid receptors, and act as SNRIs and NMDA antagonists.

  • EscapedWestOfTheBigMuddy||

    Moron.

    No, strike that.

    Ignorant moron.

  • ||

    Strike that:

    Ignorant Inhumane Scumsuckingsonofabitching Moron, Of The 1st Degree.

  • ||

    Don't hold back. I would not want yo to stroke out!! lol

  • ||

    I'm a Paramedic. Under some circumstances, I can give pain medicine (by that I mean morphine, fentanyl and the like) without a direct order from a doctor. But I am very, very reluctant to do so, for this reason. I'm well aware that the drugs I would give are not prescribed and could not be misused or sold (unless the patient can find a way to get them back out of his or her body.) So, I should be perfectly safe.
    But if a pain doc isn't safe, I'm not sure anyone is. So, unless the situation is truly dire, my patients are probably going to have to grit their teeth for how ever long it takes to reach the hospital.
    Unintended consequences can be rough for all involved.

  • Tim||

    In NY I think the EMTs need permission to use Nitrous Oxide, and that is all they use?

  • Hacha Cha||

    There is no reason a paramedic shouldn't administer opioid analgesics, if they are aloud to, if their patient is in pain and needs it. It is inhumane to make a person just "grit their teeth till they reach the hospital" if they don't have to.

  • PatricParamedic||

    You're a Paramedic? And you're "very, very reluctant" to give narcotics to your patients in need because of this case?

    I don't think I've ever called another medic a complete idiot before, but now might be the time. This greed-wracked lab coat lunatic was pushing hundreds of thousands of doses to patients that - at least in some instances - he knew damn well were abusing & dying? he & his wife were playing shell games with millions of dollars. Schneider was prescribing big-time drugs in the absence of serious H & P's.

    Does this sound like any Paramedic you know?

    I didn't think so. Next time, do your homework. If health care gets a little rattled over the storm-troopers, keep in mind "health care" gone wild is a leading cause of death in this country.

    Lord, love a duck, you people. If you're gonna cry a river, weep for the 500 citizens who die every day of the year at the hands of 50,000 bad physicians and - yes, at times - accidental treatment errors.

  • ||

    The good news is he will probably be able to get a downward departure from the 20 year minimum. I doubt he'll get 20 years at all. There's way too many grounds for reducing the sentence.

  • ||

    I'm going to start an anonymous blackmail campaign to Out the Gayness of whatever Governor his sentence is under.

    Huey Freeman: "STOP STEALIN MY IDEAS!"

  • ||

    Having lived with pain on a daily basis, I will say there is nothing worse for a human being, productively, morally, and spiritually.

    To try and stop people from getting high, at the expense of those suffering legitimate pain is not only wrongheaded and ineffective, but its also monstrously inhumane.

    Eat a nicely-wrapped bag of baby dicks, Mother Fuckers.

  • ||

    (They're FDA Approved too! Fuckwads)

  • Steve||

    To try and stop people from getting high, at the expense of those suffering legitimate pain is not only wrongheaded and ineffective, but its also monstrously inhumane.

    I agree.

    How can we help legitimate pain patients while also balancing that with societies need to keep people from getting high.

  • ||

    So far, we can't. Remember, one of the APPEALING aspects of using morphine in patients with pain is that it dulls the physical pain and eases the psychological distress. The pain doesn't hurt as much, and you care a bit less about the pain overall. The "high" from pain meds is part of what makes them efficacious.

    Pain is depressing. It tears away your hope. It is a killer--people kill themselves to get away from it. People with terminal cancer are more distressed by the pain than by the thought of dying--death becomes a relief. The opiates help to relieve that psychological/emotional aspect of pain.

    What we need to do is address why society needs to keep people from getting high, and tell them that for the most part it isn't any of anyone's business.

    Sorry, I'm ranting.

  • EscapedWestOfTheBigMuddy||

    Simple: society doesn't have a need to keep people from getting high, so it is not necessary to "balance" anything.

    Society probably does want to steer people away from wasting their miserable lives away in the relentless, irresponsible pursuit of a high; but that is a very different thing from an alleged "need to prevent people from getting high", and isn't a thing that the government is going to be very good at in any case.

  • ||

    I'm saving this piece of the thread, just fyi.

  • ||

    They (government) don't have any problem with "getting high" from alcohol! Hypocrites! Don't they even realize it is one of the more toxic drugs. It, too, can kill by drug overdose.

  • Coeus||

    Given the tenor of the discussion on this post, this may not be the best time to ask this, but fuck it. Anyone here had any experience with using the cold water extraction technique to separate Tylenol and opiates? I've read up on it, but I was wondering if anyone here had any tips or warnings.

  • Joe||

    No idea, but I don't think it is a good idea. If you don't successfully remove the tylenol you might poison yourself to death.

  • Coeus||

    Agreed, but I think keeping the total amount I use around 3000mg (the Tylenol) and taking a baby aspirin for liver protection would severely mitigate the danger.

  • ||

    fwiw, i've probably been to AT LEAST a couple hundred of suicide attempts. granted, alot of them were bullshit "cries for help" but of ALL the attempts by pills,. the only ones that were successful were tylenol.

  • Coeus||

    Duly noted. I wish there was some way to test it. I don't think there is. Damn it, I'll probably just stick to tranqs.

  • ||

    from a chemical basis, it makes sense. APAP is minimally soluble in water.

    if you really wanted to get all scientific and stuff, you could do it, and then let the solution dry, then test the melting point of what was left.

    note: i am in no way advocating you do this, merely saying that there are scientifically sound ways of being sure.

    it is far from rocket science.

    fwiw, as somebody who has been in a lot of meth labs, you'd be amazed at the lack of chemical knowledge by some of the people who make this stuff for a living. i realize it's easy to make, but if you are going to make meth, at least know what a "solute" is or "to precipitate". and don't scratch your abcessed ass, then touch your "lab equipment"

  • EscapedWestOfTheBigMuddy||

    The powers that be have only one excuse for why they do this: they just keep coming back to the "Oh noes! People will get high!" line.

    Well, I run pretty libertarian, and don't care much to start with, but I'd like to put this issue in context for everyone out there who doesn't have first hand experience of it.

    Start by thinking of the person in your life that means the most to you.

    Now, imagine that person writhing on the bed, semi-conscience but calling out for help from time to time, moaning, and simultaneously sweating up a storm and shivering.

    Try---just try---to imagine your loved one hammering a limb into any hard object they can reach just because it will make the pain change for a few moments.

    Just see if you can insert yourself into that room, helpless to make it better and knowing that even taking them to the ER probably won't help, 'cause the doctors there are worried that they might get in trouble for aiding someone who was "drug seeking".

    That is what is at stake here, and even if it isn't you today, you never know what's going to happen tomorrow.

    Ladies and gentlemen, I submit that causing these conditions to pertain when they don't have to is morally equivalent to torturing innocent people because you think it will help with the execrable "War on Drugs".

  • Michael Ejercito||

    Is there any reason to schedule drugs in the first place?

    Why not make ALL drugs over the counter?

  • Smiley||

    So my question is,, does a docter have the right to terminate a patient's life, even if he agrees that it would be in the patient's best interest????

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