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NOVEMBER 4, 2010 9:05AM

Pain Pills & the Work Place~

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 Pain. If anyone has ever had a broken a foot, burnt a hand or even had a hang-nail, you know pain. But what of others who are in constant pain? That 24/7 steady throbbing pain that never goes away. It keeps you up and turns you into someone your own mother wouldn't recognize. Now, get up and go to work, walking or picking things up all day and doing it with nothing for the pain. It might be a reality soon.

Companies across this nation are having to deal with a new reality. Not the guy who smokes a joint before work. Not the lady that snorts a little cocaine at lunch, just to "get her through the day". No, we're taking about people who have legitimate pain and have legitimate prescriptions and are allowed by their doctors to go back to work. Some of these people are getting hurt on the job and it's turning into a problem. A problem so bad it might end up in the Supreme Court. Let's hope not, my God they screw up enough things already.

This is a serious problem and from a person that has an intimate knowledge of pain, I have no idea how to solve it. There are so many levels of pain that it cannot be put into a certain category. I'm sure many of you have been hurt and treated at the ER. They will ask what the pain is on a scale of 1 thru 10. Someone with the same pain may say one, where another will say ten. Thats the only way they know to gauge pain.

Here's some of what the article in the New York Times has to say:

"Setting rules about prescription drug use in the workplace is tricky, not least because it is difficult to prove impairment. Under Dura’s policy, a prescription drug was considered unsafe if its label included a warning against driving or operating machinery, but doctors say many users function normally despite such warnings". 

I've been taking pain medication for amost 20 years. What one pill may do to me, I guarantee won't do to you. My tolerance is at a point I have to take a time-relief pain tablet and a different pain pill for break-out pain. But I'm not a great example. A man with a pulled muscle in his back is given some Loritab 10's and told to take one every 6 hours. Should he be allowed to work around dangerous machinery?

Again, from the Times: 

“I’ve seen people have their fingers cut off because they or somebody they depended on to operate machinery properly was out of it,” said Dr. Neil Capretto, medical director at Gateway Rehabilitation Centerin Aliquippa, Pa. “We treat some people in construction who say so many of their co-workers are using, they sometimes have to change careers because it’s too much of a trigger for them to go back to work after rehab.”

I've been there. Before my body starting failing apart, I had never taken so much as an aspirin. I hated pills, still do. I worked around some of these people who were medicated and you knew they were wasted but they wouldn't listen to you, saying "My doctor put me on these and told me to go back to work". My crew and I are hundreds of feet off the ground, having to depend on this guy to live through the day. Folks, what we have here it a conundrum.

From the Times:

"Setting rules about prescription drug use in the workplace is tricky, not least because it is difficult to prove impairment. Under Dura’s policy, a prescription drug was considered unsafe if its label included a warning against driving or operating machinery, but doctors say many users function normally despite such warnings".

If you go to a drug store, look at the warnings on most boxes of "anything" and many will give you the same warnings.  In-store night-time cough medicine will knock you out. Some over-the-counter pain medicines will make you just as high as something the doctor prescribes. How are companies going to deal with this. Most construction companies, which is mainy what I've dealt with, test for pot, cocaine, opiates, amphetamines. PCP and maybe a few more. Fail a test, you don't get hired. Take a random test and come up positive without a prescription and you're either fired or given one more chance to clean up.  

The Times:

"In general,” said Dr. Seddon R. Savage, a pain specialist at Dartmouth College and president of the American Pain Society, “well-prescribed opioids at a stable dose that are well supervised in most healthy people won’t cause sedation or other cognitive problems.”Dr. Cochran said that opiate painkillers can help workers do their jobs better if taken appropriately.

 

This is a problem without a solution. People get hurt, people need pain medications and people need to work. Companies are now firing people who test positive even with a prescription from their doctors. There are lawsuits all around the country and as usual, as with abortion rights or opening up our elections to anyone with money and an agenda, this will end up in the Supreme Court. Let's see, A Poor Person vs. A Big Corporation. I wonder how that will come out? 

 

There is a great article on pain pills in the workplace in this article in the New York  Times      

 http://www.nytimes.com/2010/10/25/us/25drugs.html?_r=1

I could barely scratch the surface of this problem. Give this a read and learn how pain effects the world we live in. People who are not in pain will never know what someone in chronic pain goes through, nor should they. I hope no one goes through what I go through everyday. But laws are going to be made and it may be better to get involved now before the corporate workplaces go up against the drug industry. That will be some kind of fight! 

 






 



 





 



 



 

 


 

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Thirty years ago, my husband was in a motorcycle accident that left him paraplegic. He has constant strange phantom pains everywhere and takes too many pills to work. Here is the scary thing, Scanner, some doctors refuse to treat patients with chronic pain no matter how severe because they do not want to deal with the scheduled drugs. I am afraid things will only get worse.
thank you for this. It is important and you are right, it's going to be a fight.
I work with someone who wears two morphine patches daily; these in addition to a regimen of other daily pills she takes for assorted pain, depression, and poor health. The constant mistakes and issues she inflames are incessant. Often, a portion of my day is spent in the background cleaning up behind or settling the rift she's created. I care about her and about her suffering. I don't know how to survive working near her. I can't imagine major equipment being involved. The computer is enough to terrify my day.
Mary, I've been there. Until I found this last doctor, I was turned away time after time by doctors who thought they knew what was best for me. Unless you have been in this much pain, the doctor has no idea how to treat you. They are now teaching up and coming doctors that pain and pain medications go together. I see it as taking my blood pressure medicine or my arthritis medicine. I take it everyday. Some doctors are so afraid of the DEA that unless you have enough documentation to fill up a couple of file cabinets, they will give you nothing, or something that costs a fortune but doesn't work. Tell your husband to shop around, especially at pain management places. Also, a PA will give you pain meds a lot faster than a doctor, yet they work under the doctors license. A sneaky way for the drug companies and the doctors to get the pain meds out, but not get sued. It's a crazy world dealing with pain. I hope your husband finds a doctor with some heart and spirit!
rated and related to on every level as u know my story hun..thank u for speaking out
Scanner, this is a frightening reality. Thank you for posting; informative read.

R~
I've been in chronic pain for the past ten years. I can't really tolerate most drugs, which certainly adds a wrinkle to the pain management approach. But I now work out of my home, which means I can avail myself of ice packs and frequent breaks. I can exercise when I feel okay and lie down when I don't. I also have decent health insurance which covers physical therapy and the occasional steroid injection. Pain changes the brain as much as any drug I can think of; for people without the options I have, it's got to be hell. Medical marijuana anyone?
When you are in pain you need something.. A person needs what he needs..Some of these doctors need to have some to understand.Great article my friend.
scanner ... some of the workplace "pain-pill-problem" is the constant
flow of people without pain trying to get those of us who require them
to get through our workdays ... to give them pills, loan them pills, sell
them pills, and in one case "blow me for pills" ... i have a constantly
painful condition called "Trigeminal Neurologia" that some of these
pills relieve ... have you had these lovely "painfully painless" people
approach you ??? ... lew
Are we treating patients or are we treating symptoms? What about the emotional pain some suffer from trauma? If everybody who was in pain was on drugs, we'd still have pains and we'd probably have many more accidents due to some of the side effects of the very drugs taken to control our painful symptoms, wouldn't we?
This is a tough one. I'm always railing against doctors over-medicating patients. I think that happens a lot when doctors aren't willing to take the time to investigate an ailment properly...easier to just dispense a cure-in-a-bottle. But there are people with real chronic pain who need the medication and also need to make a living. I have no idea what the answer is.
Just some thoughts, scanner. I have no issues with people poppin' pills. I do, however, have major concerns for people who become addicted to drugs and especially when these people are in contact with children, machinery, operating rooms, transport vehicles, and a variety of other professions and places where masses are found.
Mime, thanks. If they cut off the pain medication of workers, there will be a lot of people out of work.
scupper, so you know the problem. This woman sounds like she abuses her pain meds, but thats not for me to say. A pain patch should be enough, it's time release, but...,
w&b, thank you. There are millions of people in chronic pain, but no one seems to want to write about it. It's crazy!
joyonboard, thank you. The Times article gives examples of people who have been fired for flunking a urine test who were in no way affecting their job performance. It's just not right!
Nikki, I'm glad you don't have to take the meds. I refused for a long time, but it got to the point where I stayed ill and mad all the time. No sleep and the constant pain will do that. Terri is a lot happier now that I can control it, thanks!
Linda, you are so right. I know there is a problem with kids stealing their parents meds and selling them. But, that is something the parents should take care of. All people in pain should not have to suffer for the sins of people who cannot keep their meds locked up.
@belindaT
lots of medications become less effective over time.. require adjustments in dosage..to label it addiction is typical of those who do not understand that pain is a condition and a symptom and sufferers deserve to be treated not judged .. needing relief from pain should not be a stigma
Laws are always going to get made Scanner until we institute the Shakespearean solution (kill the lawyers and judges). More later.
Great post! Thanks for the links to the NYT.
This is a tough one...I work with an individual like Scupper describes - he has numerous legitimate problems, but we work with some dangerous stuff in our building, and we all worry about how much of a hazard he is!
Betamale, when I worked construction or would even see someone in a store, they are either asking for or selling some pain meds. There is a problem with buying and selling pain meds, but cutting off people who suffer is not a solution.
Belinda T., this is exactly why I wrote this. I've been on both sides. Before I started hurting, I came down on the side of, if you can't handle the job, go home. But, when it came my turn, I learned that going home is not only not a solution, but you are cutting off a persons income, which effects their entire family. People have to eat. I think companies should allow people to do safer jobs until they are well. Really, I don't have an answer.
blue, I agree. I know people who just go on the internet, find out the symptoms and go to the doctor. He has no idea if you're lying. so he has to make a choice. Now, they are making people have MRI's and such, but people who are not insured can't afford them. It is my friend a conundrum. don't you think?
b&w, pain meds have to constantly be adjusted. Just like blood pressure medicines.
Jack, can't wait for you to come back!
Conrad, thank you for stopping by. Thats a great article!
I'm an empath AND I've also a few pains [won't detail them online] myself, Scanner. If there weren't so many options available to me, I wouldn't be able to earn an income. I'm an optimist but I'm also a realist. Nobody would hire me if I couldn't perform certain duties, but that's a bridge I'll cross when it comes time.

L8r, dude.
Good luck. For your sake, and my sister's, I hope a magic pain pill arrives soon.
I was stunned when I was in Hong Kong that you never needed a scrip for pain pills. r.
No, Scanner, no one who has not experienced chronic pain over a long period of time can imagine it. I readily concede that. Thanks for this post.
Scanner... I tell people that if their pain is chronic they need to speak to their doctor about a Prialt Pump. Seriously, the stuff is fantastic and, as an added benefit, is NOT either an NSAID or an Opiate. It works by blocking pain receptors and is made from the venom of a sea snail.

It is wonderful stuff, it works and it doesn't leave you unable to function because you are high as a kite.
It's amazing that people can take high doses of opiates and still drive and appear to function normally. "appear to function normally" being the operative words. Statistically, as a group they are going to be more dangerous in workplaces requiring mental or physical dexterity, even though some will do fine

Buffy
This is one of the reason I keep opposing the raising of the retirement age. Not all people work in a cubicle sitting down. Many do physical work and are in the situation you are in. One can work to seventy sitting down with hemorrhoids his greatest risk but talk about working to seventy with a guy on an assembly line. R
I spent most of my life in pain, now I am learning to be a healer without drugs that make your head feel heavy and clogged.
I am learning to heal myself through plants and energy.
Thanks for this essay on a very real problem, always near the surface of life for those who suffer.
rated with TLC
Yeah, it is not an easy thing to deal with, babies and bathwater kind of problem: where do you draw the line.
Unfortunately, if you have not been in that position, you lack understanding of what it is like to be in agony all the time.
Fortunately, knock wood, I cannot put myself in that category, but did get close enough once to get the idea.
Hopefully employers can be encouraged to remember that there for the grace of god, go I, although in cutting and driving, I can see the point.
They will do anything and everything to insure maximum efficiency for the corporations even if it means coming to your house and shooting you in the head when your productivity falls off. It will be interesting to see how they rationalize that one but if they can pass a law saying that Dale Earnhardt Jr is not as good a driver as my 75 year old brain damaged mother because he has ingested 3 beers then no manipulation of public opinion is beyond them. In fact most of you will probably applaud the slacker shooters and laud them as hero's. Grieving their deaths at the paws or hands of the occasional Rottweiler and quick fisted slacker.
A subject near and dear to my own life today. I worked for five+ years in a factory where ordnance was built. From mixing the explosives to building finished rounds. Some of the explosives were sensitive enough to explode with a three foot drop to a solid surface. Combine this with the fact that in order for them to perform properly as ammunition, they had to be hydraulically pressed under extreme pressure and you see that this was a truly dangerous place to work. One day as I ran a machine the placed these high explosive rounds in belts for use in aircraft guns my glove was caught by the flexible link belt and it pulled my hand into this machine. I was forced to violently pull my hand out to keep from losing my fingers and tore my rotator cuff and the cubital nerve causing prolonged and severe pain. I was allowed three days off and was told that I must return to work under the influence of oxycodone, percocet and gabapentin. Needless to say I was a little out of it, yet had I missed work I would have been punished. It wasn't until my own doctor intervened that I was allowed to miss more time while I awaited the workers comp approval to repair the damage. I spent the better part of two years using these drugs on a very dangerous job with no consideration for them at all. In higher paying jobs employers are eager to replace people who are on a higher than entry level pay scale so if I had missed more than the three days allowed in a month for ANY reason I would have lost my job. I was basically forced to work under the influence of strong narcotics and CNS depressants. The possibility for me to make a mistake or drop something was present every day and still there was no escape from the fact that even though I was injured on the job i was not able to do what I thought was best, stay home until such time that I wasn't on those drugs. More people are injured on the job every day and thanks to our system of assuming that an employee is never sick enough to justify missing work the number will begin to skyrocket soon. Injury will compound injury and the end result will be a nearly sedated workforce and unsafe workplace for everybody. This place in particular risked the lives of not only the injured but the uninjured as well. Literally, for no reason other than to try and force an injured worker to quit. It isn't right or fair to anyone to make a person work in that condition.
My heart goes out to anyone who has to work thru pain and I cant imagine a law that would test for pain pills. I see a similar situation with being a diabetic in the work force. You get accused of being drunk and you have to work whether you are having a low sugar episode or not. A hostile work environment is a terrible thing.
Unfortunately, the person impaired person is not always the one who is in the most danger from his/her impairment. It's often the next person down the production line.
@ Zanelle, The place I worked tested for opiates not pain pills and they didn't care if it was something prescribed or not, just if they were present. Fail once and get tested twice a week for a year, fail twice and you were gone and they based that on the opinion of the company doctor as to the levels of narcotics being consistent with your prescription, not a hard figure only his opinion.
Great post. Worked for years taking hundreds of mg of oxycontin and roxycodone each day, plus a 90 mile one way commute. I'm now retired and have a difficult time remembering how I did that, or anything else from that time.
Rated.
I was thinking how fortunate I am to be retired, but then it occurred to me that I risk my life every time I drive down the road. How many other drivers are stoned out of their minds? It's a wonder our highways haven't turned into demolition derbies - yet. Good piece, Scanman.
Rated for information and content. Well done!
Important topic, I was just going to blog about it myself, but your posting here definatety beats me to the punch. The question that rattles me is, can anyone be a master of these medications? Is it ever safe for people who are prescribed opioids to handle large machinery? But would it be okay for someone with a desk job to use these with doctor's orders? Difficult and unknowable because each person reacts to meds in their own way.
The ultimate answer may come from some sort of a brain scan that can quantify pain by examining its sensory effects directly. When that happens, it may take some of the ambiguity out. It won't fix the problem but it might help stop some of the abuse.
Thanks Scanner - great discussion. Everyone is affected in one way or another
very interesting! going to go read the NYT article now.
I was thinking about you last week, Scanner. I had one of those headaches (not migraine) this sits on the top of my head and refuses to leave for several days. No safe amount of any OTC pain pills works. If I had to live that way day in and day out I would go out of my mind. I had no idea so many people find themselves forced to work either in debilitating pain or under the influence of powerful drugs.

Lezlie
My biological Father has fibro, and is on regular pain killers (probably ones that wouldn't even touch your pain, as they only keep his at about a 5- he refuses to take more) I've been on the phone with him and had him go to answer the door and not remember to come back. He has been playing backgammon his whole life and I can beat him easily now. He is not currently working thank god. I worry about him driving to be honest.
We need better disability care and funds for those who need it. Pain killers are memory and mind killers for most people, people should not be forced to work while on them. Chronic pain is a job to handle in and of itself, we should not further stress those people's bodies with other work. Our care for our sick is lame in this country.
I am a firm believer in RELIEF..if you need it, you need it. Period. I have an addictive personality and know if I rely on pain meds, I'd be hooked. I ama firm believer in exersice..example, I tossed and turned last night with that odd leg pain crap, not any particular area, ALL over..so much I had to go on the couch so I didnt keep Steve up all night.2 nights of real pain(not as bad as u, I am sure). Point is 3 days ago and before NO pain..what did I do different? I didnt got to the gym for 2 days..can you believe that? For real, that is all it is..there is sooo much to be said for getting your blood moving, whether it be the gym, dancing or having a little whoop ti doo time..lol! Seriously!
Cindy, how right you are. Exercise helps, along with diet and many other things. Some people go to Chiropractors and get relief. Some use Acupuncture that helps. Drugs are only one option. Unfortunately for me, I've had three hip replacements and a metal rod going from my right knee to my ankle as a result of an accident. Along with gout, which is one of the worse kinds of pain a person can have, I have the usual arthritis, tendinitis in my shoulder and both hands are in the process of drawing up to be almost useless in a few years. Thats why my typing is so terrible. Pain medicines are my only option, but I do so wish I could get out and exercise just by walking. Thanks for coming by my friend!
scanner - Indeed! And very well researched and written! I think this is one of your best posts. I've seen first hand what pain pills can do to people at work - it is very risky, both physically as well as professionally. I agree - this is a serious issue and solution is a shadow that cannot be well grasped.
Thanks for the good advice, Scanner. Very thoughtful.
James writes: "It's amazing that people can take high doses of opiates and still drive and appear to function normally."

I'm one of those people. I take narcotics four times a day for arthritis. After a short while your body adjust to the narcotics, and you no longer have side effects such as being dizzy or sleepy.

There's no evidence in the medical literature that someone taking long-term stable doses of narcotics can't function or can't be employed. That said, surely there are a few occupations -- airline pilot, working in an explosives factory, etc. -- where people on narcotics shouldn't work, just to provide an extra measure of safety. But there's no reason at all why people on narcotics can't do the great majority of jobs.

Concerning addiction -- anyone who takes narcotics for a long time will become physically addicted. What that means is that if they stop taking narcotics they will have symptoms of withdrawal. These include sweating, diarrhea, feeling agitated, and feeling like you're "crawling out of your skin." Most of these can be managed by slowly reducing the dosage over time.

People with chronic pain need to see a pain specialist, at least initially. Once the specialist has gotten the patient to the point that he or she has adequate pain relief, then the primary care provider can write the monthly prescriptions.

Going to a primary care provider without first seeing a specialist typically does not work out very well. The PCP often makes the mistake of under-prescribing narcotics. This often leads to a condition called "pseudo addiction," in which the patient exhibits what appears to be "drug seeking behavior." In fact, what's happening is that the patient's pain is not being adequately controlled.

Another problem is that PCPs often fail to prescribe slow-release narcotics, leaving the patient with short-acting meds. The patient is then in the situation of "chasing the pain." This often results in taking too much narcotic while still not getting good pain relief. A better approach is to take higher doses of slow-release narcotics, using the immediate release pills only for "breakthrough" pain (exacerbations of pain).

Anyway, thanks for writing a good post on an important topic.
mishima666, great comment. In the article, it explains about pilots and other specialized jobs that you cannot be on pain meds. You're right, once a person gets used to their particular meds, they have no effect on operating vehicles or even working around machines and such. Of course, alcohol combined with pain meds are also no-no. A big problem with getting started on a regimented schedule, is the right doctor. I was surprised to see that older doctors, out of med school for years, have an aversion to putting people on pain meds fearing addiction. I take my meds, pain and blood pressure etc., the same way, just another pill. I also think someone who is in chronic pain cannot get addicted the way a person who abuses pain meds does. They take hand fulls and their bodies need the same amount. I do know they give everyone else a bad name by making it harder on the person who is in true pain! Thanks for stopping by!
Scanner, I really learned from this post and the comments. I worked in addiction treatment, and know the docs worked closely with the pain clinic to try and figure out how to manage pain without feeding addiction... what I think would really be a helpful post is what it is like to live with chronic pain; clearly, many here have that experience, but more of us do not. How does one learn to live with pain? How did it start? Aside from meds, what is most effective? What are the different experiences of pain? I think pain is one of the things most of us fear...
I'm going through this now with situations that involve a cracked bone in my back and kidney stones. I have different levels of pain and different pain killers. It's kinda scary. Plus, any extended use of narcotics introduces everything from constipation to hallucination into the equation.
I have been on morphine for some time. I have no drowsiness or other incapacitation from it, but as you say, I take it like my blood pressure medication -- as prescribed and on time. I was put on pain killers after seeing a pain management physician, then went through two years of testing to determine it is Figromyalgia on top of a replacement knee, arthritis and migraines. I also have narcotics for breakthrough pain but mostly use those when I have to at night. I function well in spite of the fact that all those drugs don't completely quell all the pain I live with. Those who don't know what I take have no idea because I am not impaired because I do not abuse my drugs. It makes me sad that this has become an issue. I am disabled and don't work, but I would take issue with others if I did.
While I don't suffer real pain, in fact, none at all, I do find it increasingly difficult to shoot up at work. The perfect speed ball requires quality heroin and cocaine and I have been reduced to second rate providers because of the economy. I am an airline pilot. Thanks for the sympathy. I have a monkey on my back and the monkey never pays for anything.
I was recently medi-vacc'd from Maui to Honolulu for heart surgery. (Angioplasty, which is not available on Maui-----imagine that!?)

Awaiting the surgery, the cardiologist there prescribed nitro for my PAIN. Nitro opens the arteries but is not a pain-reliever.

What the fuck was that about??? I was in agony waiting for the surgery.

I just keep hoping that these dumbshit doctors will endure their own parents suffering as they age, and step up to alleviate suffering for the rest of us. (Or maybe they will suffer on their own and get clued in?)

Hope springs eternal.

Love love love you, as always.
And to Senor Price: Please tell me where you live and I'll help you find a dealer........I'm handy that way.
Good post Scanner.

I take opiates for a herniated disk. I would be lying if I said the hostility in the workplace, medical profession, among politicians and society in general toward those managing chronic pain and many other health problems, did not contribute, at least in small measure, to my decision to go on disability five years ago. The disability is mental health related, but I might have waged the war a bit longer if the odds on virtually every front hadn't been so stacked against me.

I did manage to function, albeit very poorly, for many years. Eventually however I just reached the point where I no longer was able, nor did I even want for that matter to wage arduous, mostly losing campaigns on so many battlefields where the odds were stacked against me. The herniated disk was the straw that felt like it broke my back.
I'm normally more literate. Sleep deprivation. I meant to delete the second paragraph.