New Black Box Warnings: FDA

I have a hell of a toothache.  A couple of months ago I broke a tooth, and went to a franchise-type dentist who took emergency cases.  One of the down sides of being a professional vagrant is I don’t have a regular dentist. 

For a little over $1000 I walked out with a new crown and instructions to call if I had any problems.

I did have a problem, before I even left the office.

I felt that I should have had a root canal before the crown went on.  I know my teeth.  They are ornery, pesky things.  They operate in strict accordance with Murphy’s Law:  anything that can go wrong, will go wrong. 

The dentist assured me that the nerve looked fine, and he hated to mess up a basically healthy tooth.

A couple days later, the thing started hurting like a sonovabitch.  I called the dentist, who immediately assumed I was a drug seeker and blew me off, saying that it might take a few weeks to settle down.

It hasn’t.  In fact, it’s getting worse.  Now I have to look for a dentist who will…but wait, it’s Labor Day Weekend!  No dentist till next week, when I have to run up to Michigan to get some warrantee work done on the old brand new RV.  Maybe I’ll find a dentist there, with a lot of luck.

So, in order to buy some time and have at least a few hours out of misery, I took two of my hoarded tramadol tabs.  Now I have maybe 20 left.

Then I opened my email, to find a bulletin regarding a new FDA policy, intended to protect ourselves from ourselves:  black box warnings on both opioids and benzodiazepines, warning that they must not…Black Box MUST NOT…be taken together, because of the potential of respiratory depression leading to death.

A Black Box warning is the strongest labeling there is.  This means that in a time when even being prescribed pain medicine is becoming a remote possibility, those of us who take benzos for anxiety disorders and/or movement disorders, seizure disorders, or insomnia, will have an even more difficult time obtaining effective pain management.  Doctors who prescribe both meds at the same time will open themselves up for censure and lawsuits.  Pharmacists are being given increasing power to simply refuse to fill prescriptions.  They don’t have to, and if the FDA issues black box warnings, they are fully within their rights to refuse to fill prescription A if the patient is known to be taking prescription B.  In fact, if they do fill it and the patient has an adverse effect, the pharmacist is liable, can lose their license, and can be sued.

This is of direct concern to me.  My neurosychiatrist, who unfortunately has retired due to failed back surgery, hammered out a drug cocktail during the course of our 12 year clinical relationship, that effectively treats my bipolar, PTSD, and social phobia.  It includes 3 types of benzos.  All at once.

It also helps with the muscle spasms that cripple me day and night.

Now I fear that when my prescriptions run low, I won’t be able to find anyone to prescribe these lifesaving medicines because they are “too much.”

Worse, the degeneration of my spine is getting to a critical point.  One of the bones in my neck is rotating in such a way that it is pressing against my spinal cord.  I’m going to need surgery soon.  Major surgery, to fuse three of my cervical vertebrae and lift them up off the nerves they’re pressing on.

I won’t describe the surgery, because it makes me sick even to think about it.  I’ll just say that it involves lots of chopping up bone and remodeling.  Very, very painful stuff.

So…in today’s anti-pain med climate, what’ll it be?  Black Box Warning ahead!  Do I get to continue my benzo regimen so I can maintain a semblance of normalcy, and not be a hypervigilant mess, or do I get a modicum of pain relief after having this spinal carpentry fest?  Do I have any say in this matter?

Last time I had spine surgery, I got sent home with zero pain meds.  None.  And that was in 1987!

Why on earth did this happen?

Because I happened to joke to the pre-op nurse who was taking down my then very short med list (one med!) that I took Xanax for the three days before my periods, and that I was addicted to not having PMS.  She wrote down that I was addicted to Xanax!  It was recorded in my chart that I had admitted to being a drug addict.  So when I called the hospital to ask for some kind of postoperative pain relief, the neurosurgery intern scolded me about being a drug addict seeking drugs.  No pain meds.  And that was a relatively minor procedure, compared to the one I’m facing.

I really don’t know what to do.  Sometimes I wish I’d just die in my sleep, so I wouldn’t have to face this surgery and the prospect of being helpless, in agony, without the possibility of comfort.

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25 Comments

  1. Unbefuckinglievable!

    Reply
  2. unreal. I am in the same boat because I take ativan and my opioids, not together of course but I doubt the damn pharmacists are going to see it this way. Oh joy. Just kill me now. I am with you in dying in my sleep. Gentle hugs

    Reply
  3. They screwed around with my medicine twice when I was in the hospital
    Two different times
    It will probably happening again
    Fuck they don’t care about you or I just about brother addicts
    EpiPen, Narcan, and what ever else
    Accept the obvious
    Which would to leave us alone
    As in prescribing for new patients
    And not those of us who have been taking it
    Lawyers,money,sons and daughters
    The Sheldon Perspective

    Reply
    • Oh, Epipen? If you’re rich, yeah. Now they’ve jacked up the price, and most insurance doesn’t cover it. Fuck a bunch of that, I’ve let mine expire. “Half in love with easeful death.”

      In the hospital, like for your gallbladder??? Or the other kind?

      Reply
  4. So fcked up. Seething right now.

    Reply
  5. It seems like the more governmental interference/intervention there is between a patient and their doctors, the worse the situation is overall – the rise in suicide rates and illicit drug overdoses is proof. It’ll only get worse. They’re idiots. I’ll comfort you…me and my giant bottle of tramadol will be here for you.

    Reply
    • I agree. Medical practice has been shanghaid by business, the insurance industries, and the government agencies that are all too happy to cave in to the agendas of Big Money. I’m glad you have a lot of tramadol…..it did help my toothache, although it also made me nauseous. But I know how to treat that, at least.

      Yes, this new fuckeree, as you so eloquently say (I love your wordplay!), will indeed spark a whole new generation of suicides. And so the pendulum swings.

      Reply
  6. Geeeezzzzus! Unreal!

    Reply
    • Sigh. In theory, it’s a good thing to be very careful when mixing two drugs that can cause respiratory depression. It’s another to take away the discretion of doctors and patients. Many people have very good reasons for taking these drugs together. What’s needed is careful clinical assessment and good communication, not boiler plate hard line legislation of medical practice.

      Reply
      • I know its a bit different over there, but here, there was a trend not that long ago, where they were dishing out pills left right and centre … some needed, some not. Now we seem to be heading towards wherever it is that your at … where they’re blaming the patient for to many meds, the variety of meds, addiction to meds etc etc … Everyone I know that takes benzos also takes pain meds, there are no exceptions. So at the minute, they are being encouraged to do this but by the sounds of it, these will be whipped out from under them! … I (partially) stopped these meds after googling them and finding there were side effects, which I was displaying, to having both lots of meds in your system at the same time. My doctor said I was being paranoid! It seems like the whole thing is beyond ridiculous and the powers that be, really couldn’t give a rats ass about what works for the individual! … sorry … rant over lol … you have my sympathies anyway!! xo

        Reply
  7. I need Xanax to even think about dental work. And dentists seem to have some kind of immunity to all the harm that they do. Dentists suck.

    I have a feeling that the label of “drug addict” is somewhere in my medical records, too. Those two words will haunt you and your medical records for the rest of your life. I’m not sure what you can do about it, except to document the error, maybe with a letter to the dentist that messed up. Trying to explain what happened to new providers will only make you look more like a drug seeker.

    Reply
  8. I hate the fact “they” need to save us from ourselves. Call me wacky, but unless I’m going to harm someone else, let me do what I want with my body!
    Who cares if I need 15 pills to make me feel better? I’m helping the economy 😉
    About your tooth, I just had a root canal done that hurt for weeks afterward. This was my 10th canal… I know how they are supposed to feel afterward!
    Turns out the crown was high and all it needed was a sanding down as it was hitting too early. Luckily, pain was gone instantly. Fingers crossed that’s your issue. 😆

    Reply
    • I wish. The occlusion is good. It’s sensitive to heat, cold, and pressure…not good.

      I’m sorry you’ve had such a close relationship with the endodontist…not such a happy marriage 😔

      I agree with you. Way too much “parentalism” going on here. I’m a Libertarian, mostly. I’m not thrilled about people getting addicted to painkillers. I think the vast, vast, vast majority of people who take pain pills do so because they are in pain and the pills help their pain. A very few do actually become addicted. In my experience, people who become substance abusers are going to find a substance to abuse, whether legally or on the street. The heroin business is booming now that people with legitimate pain, being abandoned by their doctors, are seeking relief anywhere they can find it. See, that’s proof they’re all addicts! Right???? Well, maybe they WILL be, now.

      Reply
  9. because ‘drug war’…

    Reply
  10. Horrible. Especially tough when traveling. When I was an undergraduate, I worked part-time as a pharmacy assistant at a local small neighborhood pharmacy. We knew the difference between our customers who took medication as prescribed and addicts who sought medication. Their BEHAVIOR differed. The addicts shopped doctors, pretended to be doctor’s office calling in scripts, and sought more than their prescribing doctor wrote. Now, ALL patients are treated as if the pay are addicts seeking drugs and as if ALL patients react the same to prescribed medications, which we do NOT. But, I’m preaching to the choir here.

    Reply
    • Hi Kitt,

      I’d appreciate it if you’d click on the link and read my comment on the original post. I believe our voices need to be heard. What you have said here speaks to an issue that needs to be brought before the public. Most physicians and pharmacies are NOT being overrun with drug seekers, and yes, they exhibit some very predictable behaviors. For instance, when I worked in the ER, there were people who frequently “lost their medicine.” And there were a few bizarre complaints that recurred, in known patients. But, like you, we knew what they were up to. The vast, vast majority of people in pain were, well, people in pain. The biggest problem I faced as director was that some of the docs would grow resentful toward frequent visitors with episodes of acute pain, for instance migraines, and would not treat them. Now I guess they’re going to kill us with kindness. It’s for our own good 😠

      Anyway, please read my comment and let me know if you have any ideas.

      Reply

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