War on Patients

For all the various experiences I’ve had as a disabled person, a long distance move is a relatively new one. I’m lucky in a lot of ways because the place I’ve moved to isn’t completely new. Although it has been 13 years since I’ve lived here, my parents have been here that whole time. As a result, I have access to certain resources that I wouldn’t have otherwise had. Among these resources is faster access to a family doctor – the same one that has served my family since I was a kid.

I’m lucky because that’s not the case for most people. There is currently a pretty significant shortage of Family Doctors or General Practicioners as they’re sometimes called. Your GP is meant to be the point person of your medical care. They’re responsible for managing the big picture of your overall health – receiving updates from all your specialists, all test results, providing referrals to specialists, and in many cases managing the vast majority of your prescriptions.

As part of my move, I had to transfer my prescriptions from Ottawa to here. Since I was using the same chain of pharmacies, I didn’t much foresee a problem. That’s because I didn’t know about a law that prevents pharmacies from transferring prescriptions that are categorized as narcotics. It’s part of the ongoing war on patients masquerading as the various wars on drugs. The problem is that narcotics are the recognized treatment for a variety of different conditions including ADHD. If I needed a refill of my medication, in this case Vyvanse, I would need to find a family doctor and get a brand new prescription.

Like with most of the laws surrounding narcotics, including but not limited to opiates, they’re based on false narratives around the use and misuse of prescriptions. The belief is that these drugs are so addictive that colloquially patient becomes synonymous with addict. The belief is that the people who take these medications are either selling them or desperately trying to get more to take – not out of medical necessity but to “get high”. We know through studies though that most of these beliefs are based on false assumptions.

For one, while these drugs can be addictive, people using narcotics as part of a valid treatment regimen are significantly less likely to become addicted. It’s not about getting high, but about treating the very real symptoms or conditions that we deal with.  As such, when people with chronic issues come looking for a prescription renewal or through tolerance issues end up needing a higher dose, it has little to do with addiction and more to do with just needing their regular treatments.

Equating patients who use a certain drug with addicts is problematic for both sides. Not only does it put patients in the position of constantly having to justify their need for their medication, make it harder to get treatment regularly and build distrust between doctors and patients, it also harms addicts by continuing misinformation about the nature of addiction.  It doesn’t address the sources responsible for black market drugs, and continues to treat addiction as a legal problem of access rather than a medical one, and something that should be met with treatment rather than punishment.

Many anti drug advocates and prescription fear mongers push harmful false narratives about the validity of different conditions and treatments. In order to invalidate the need for certain medications, it’s not uncommon for there to be claims that certain medical conditions are fabrications of the pharmaceutical companies in an effort to push certain drugs. These claims do a lot of harm to people who struggle with these conditions and already have a hard time getting the accessibility they need.

Another important bit of misinformation perpetuated by many of these laws is that while People of Colour are most often hurt by these laws and targeted by the medical system as the cause of the problem, it’s actually white people who are statistically way more likely to abuse prescription narcotics. White people are more likely to be responsible for such medication entering the black market, are more likely to abuse the system to get fraudulent prescriptions and refills.

Unfortunately, despite the actual reality of the situation, this lie affects the quality of care for many people of colour who have a harder time getting adequate treatment, even in cases where the medications are not controlled substances. Black children a significantly less likely to receive pain treatment in the same situations where white children are, black children are significantly less likely to receive diagnoses of learning or cognitive disabilities and instead have misbehaviour labelled as being attitude problems or tendencies towards anger or violence. Black mothers are significantly more likely to suffer post-partum complications including death. None of these are the result of any sort of physiological predisposition, but the result of deeply ingrained biases help by people who work in medicine.

A bigger predictor of whether or not someone will become addicted is if they are isolated socially. In those situations, the intoxicant or addiction in question becomes a means of escape from a mentally intolerable situation. Social isolation doesn’t have to be forcefully imposed through physical separation either. Shaming, stigma, and so on, all create circumstances where a person may feel the need to self-isolate as a way to avoid those feelings.

Every time that a patient is made to feel like they’re doing something wrong by taking their needed medication it creates a stigma, it creates anxiety about whether their symptoms are real, second guessing, a tendency to let serious issues go untreated for longer out of a desire to not seem too eager, and ironically creating a greater need for stronger medications and in larger quantities. These fears can make patients feel like they are addicts, even when they’re not, and in turn act in a way that seems to confirm this suspicion in their own minds and the minds of others.

If you already think you are doing something wrong in just taking your medication as needed, then the temptation becomes to start engaging in riskier behaviour. Why not take a little extra on days when you need the boost? Why care about combining it with other medications, even when counter-indicated? Additionally, the temptation becomes to alter the truth regarding frequency of use, leave out vital information about side effects and other related or unrelated symptoms.

When conditions are serious enough that patients have to deal with doctors who are legally barred from giving them sufficient doses of their medication, or from giving more than 3 refills at a time for a daily medication and being unable to prescribe more without an appointment, it not only clogs the system while also driving patients to the black market to get what they need just to survive.

The many laws that are being implemented, the fear driven narrative around both narcotics and addiction, will do more to drive up the amount of addiction and black market traffic than it will prevent. They create a culture of med shaming and patient isolation that will make the problem worse.

Take the law standing in my way currently:

Presumably the point of the law is to prevent people from transferring prescriptions to multiple pharmacies and so possibly have it filled multiple times, selling off the extras. It’s not an entirely implausible idea, and I’m not saying it can’t or doesn’t happen. But while the law may stop a few dealers, it creates dangerous situations for patients and in particular those with chronic conditions.

I’ve already written about the time that fear of opiates, of narcotics, led doctors to almost kill me by pushing me into a dangerous post admission withdrawal. I’ve also made mention of the links between untreated pain and the development of chronic pain.

In the case of this law, the inability to transfer certain prescriptions if they’re designated as narcotics, forces patients into a nearly impossible set of circumstances.

The only way to continue getting your medication is to get a new prescription.

I’m in Canada, that should be easy right? I don’t even have to PAY to see a doctor at a walk in clinic.

Except, all walk in clinics now have a rule against prescribing Narcotics or refilling existing prescriptions.

So perhaps you go to the hospital, which would not only land you on THE lowest priority meaning you will likely be waiting hours to see a doctor, but is still not a guarantee since the doctor may decide that since you are literally just there to get a prescription, that you’re a drug seeker.

What does that leave?

The only real way to get the prescription you need is to get a family doctor.

The problem is, there is a shortage of family doctors in Canada. Many are already heavily overloaded, so that it can take a while to get more regular appointments. Additionally with many rules heavily encouraging family doctors to offer walk-in-hours in order to reduce the burden further on emergency and urgent care rooms, there are even more limits on the amount of time a doctor can devote to patients.

When you deal with chronic illnesses the search for the RIGHT family doctor can be even more difficult. I’ve had family doctors who just didn’t know how to handle my Crohn’s Disease, who because of this, didn’t bother trying to differentiate between it and any other possible illness. It was like the fact that I had this one condition, meant I couldn’t ever have any other kind of illness. Still others didn’t understand the effects of immunosuppressants and how they can impact physiological responses, leading me to walking around for two months with swine flu.

Additionally, chronic illnesses come with their own specific sets of co-morbidities to look out for, their own restrictions surrounding things like acceptable meds, diets, behaviours, and so on. A doctor unfamiliar with and unwilling to research these restrictions may be more likely to ignore important clues regarding the development of related conditions or med side effects, and predisposed towards assuming their patients are hysterical or given towards hypochondria. This blog has featured guest posts from patients who have been blinded because doctors ignored their responsibilities regarding certain medications and chose to excuse symptoms as being nothing of concern. My own history includes doctors who prescribed medication I was allergic to, or that is known to react badly with crohn’s disease.

Time may not be something patients have a lot of. Regardless of whether you plan for your move or not, it’s not always possible to make sure you have an adequate stock of your medication to facilitate the move. Insurance companies, and laws, can both dictate how often you are allowed to refill your prescriptions as well as how much you are allowed to have at any given time.

So now imagine moving somewhere and finding yourself needing a refill in two weeks. Even someone completely abled would struggle with finding a doctor in that amount of time – so why are  disabled people expected to pull of the impossible or put their lives and health at risk?

For all that narcotics can have side effects of taking them, there can be significant side effects to not taking them as well. Many meds can alter your body’s chemistry, so that the sudden disappearance of those medications can leave you in a dangerous state of withdrawal, or even result in serious deficiencies in necessary biochemicals such as neurotransmitters and hormones.

In addition, the conditions being treated can flare seriously when suddenly they’re no longer being treated. This could mean anything from a critical spike in depression, in ADHD, pain, anxiety, and so much more. This is a dangerous state, and it is being forced on patients with no real system in place to avoid it when it occurs.

Even when a solution can be found for this, the end result hilariously becomes that two different pharmacies have two different prescriptions for the same medication. This circumstance seems significantly more vulnerable to fraud, not even by patients but by anyone aware enough of the situation and able enough to take advantage of it.

This fear of addiction and narcotics has created a situation where doctors are scared to prescribe certain treatments based on their current street value. I’ve honestly had doctors suggest alternative medications because the one mentioned was currently $10 per pill, as though the value of the medication suddenly rendered my current condition invalid. Either my condition is real and requires whatever medication best treats it or it’s not. If it’s not, why are you prescribing anything at all?

When a war on drugs is based on misinformation, bad assumptions, and without taking into account the realities of those most affected by them, it becomes nothing more than a way to pretend you are actually doing something about the problem while actually just waging a war on patients – those in need of addiction treatment or otherwise. If a law targeted at improving public health does so by actually putting members of the public at risk of adverse health effects, what good is it?

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War on Patients
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