* patient such as your friend has excruciating pain, requiring the heaviest of the narcotics (say oxycodone/oxymorphone, instead of a "mere" hydrocodone that you'd get for wisdom teeth or something ).
* these narcotics are so incredibly dangerous that they must be taken exactly as prescribed for the following reasons. 1) Patients have a temptation to take an extra one (or snort one) to achieve a euphoric and addicting "high" that can be irresistible once its experienced. 2) In some cases taking even one or two extra pills can kill the patient. 3) Patients have incentive to Not take them because some pills can fetch up to $40 EACH on the black market. 4) not taking them exactly as planned can cause a tolerance buildup or reduction, which can stymie the physician's efforts to find the safest minimal and effective dose for continuous pain management.
* To combat all 4 of these factors, pain management specialists enter into "contracts" with their patients that they will treat their pain, if and only if, they agree to take the pills EXACTLY according to plan. To affirm compliance to this plan, the patients are subjected to random drug testing. Not just to see if they are getting high (over using them ), but also to see if they are using them at all, (i.e. not selling the pills for a massive profit ). IIRC, if you show up to your test and they find no painkillers in your urine, you can be taken OFF the plan, i.e. no pills for you.
tl;dr they drug test patients to make sure a precise plan is being followed because there are at least 4 separate "failure modes" to chronic pain management.
I learned most of this from news articles and reading junkie's tales on /r/opiates. I'm not an expert, nor user, but I just find the whole topic very interesting. Please correct me if I've said anything wrong.
People have agency. And should be allowed to make their choices. Especially in cases where not allowing them to make their own choice starts hurting innocent people. And by hurting, I mean that very very literally in this case. The type of pain that causes people to end their lives. Caused by a system more afraid of a bad decision than of leaving people alternating between howling and sobbing in pain for days.
That also includes physicians. Their asses are on the line for every patient they treat. If one of their patients OD's, a full death investigation will be done, possibly including DEA, possibly including the medical board.
If any perceived misconduct is found on behalf of the doctor, s/he could be sued, censured, fired, or perhaps even jailed. When you study for 12-15 years to get a single job, the emotional pain from losing it all isn't far from the physical pain of what your friend went through. Not to mention that doctors have empathy, and would also feel guilt and remorse if their actions killed a patient.
Even though it was a painful, humiliating ordeal for your friend, that's better than cavalierly throwing opiates at her which could have possibly killed her.
> People have agency. And should be allowed to make their choices.
I am not trying to sound like an asshole here, but with pain pill addiction, you don't have agency. that's precisely what addiction is ! You lose agency, willpower, and even develop narcissistic defenses (in some cases) to provide a psychological pathway to defend the addiction. You become a slave. This is exactly why they are regulated!
As for over prescribing, that should be no more dangerous than any other medicine. If my doctor gives me 800mg ibuprofen and I take 10 of them in the morning, he isn't responsible. As it should be for pain killers.
As for addiction sucking, I also already agreed it is a problem, but when I weigh it against innocent people, who didn't make a conscious decision to do something wrong, I find it the lesser of evils to let people make that very bad choice. Do I really need to say I don't have a problem with doctors monitoring patients for addiction? But extreme measures are being taken, not out of an over abundance of caution for patients but because the DEA is throwing doctors in jail.
I don't have the data to back this up, but I don't think the DEA is the primary impetus for drug testing patients. What I surmise is that most likely, a double-blind academic study was done, just like how they establish every other standard treatment protocol. Likely, they determined that drug-testing patients significantly reduces the incidence of OD and abuse, i.e. reduces morbidity and mortality. Being scientists, they adopt the technique that works.
There is a big difference between treating a one-time injury and writing a prescription for 20 pills, versus someone with a pinched spinal cord that's never going to get better, that gets a permanent supply. For the latter, you go to a pain specialist. IIRC GP's dont even get involved with that.
> that should be no more dangerous than any other medicine
an NSAID "should be no more dangerous" than an opiate ? Please tell me you are aware that unrelated molecules will have dramatically different pharmacological effects on a human body.
If a doctor gives you access to a deadly product, one that could kill you if you go over by merely a single pill, and doesn't do everything they possibly can, then a jury, medical board, or (in rare cases) the cops might have a case for malpractice or patient endangerment. Anyway, I dont have any more fuel to back this argument up, but I wish your friend the best, pain-free life!
It's a fucked up way of dealing with people we suspect have a health problem to take an action we know makes the problem substantially worse for a large proportion of them.
The irony is that medical grade heroin in predictable doses is one of the safer alternatives, and far cheaper again. But of course these people do not get medical grade heroin - they get street heroin cut with anything from cheaper drugs to brick dust.
If the line is between people suffering horrendous incomprehensible pain and people making a choice to abuse drugs. Well I'm pushing that line right up against the people who get the luxury of making a choice.