Pain Crisis: Chickens Come Home to Roost

Pain Crisis: Chickens Come Home to Roost; Alex DeLuca; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2008-08-07. Modified: 2008-08-08.

Permalink: http://doctordeluca.com/wordpress/archive/chickenroost/

In Reference To:
Source of Pain Pills Dries Up – Blackford, 2008-08-06
Kentucky Herald Leader (link to source broken, full text below)

All I can say about this article is to echo Malcolm X: the chickens have come home to roost, America. The article (below) well describes the public health chaos that is the predictable consequence of clinical and public health authorities abandoning their real mission to uphold the medical standard of care for their citizenry, and instead focusing exclusively on the policeman’s agenda which prioritizes ‘catching a few addicts’ over providing adequate pain management for legions of innocent patients.

You wanted a drug war? You’ve got a worsening pain crisis as the direct result. If you think catching one substance abuser is worth the medical abandonment of a hundred or more innocent chronic pain patients, then your team is winning.

This country has no coherent strategy to deal with the ongoing, very well documented crisis of routine undertreatment and denial of treatment for chronic pain. And instead of solving the law enforcement problem of massive theft at the pharmacy and wholesale levels (in fact a Freedom of Information Act has to be filed to force DEA to disclose these databases they had been hiding) – instead of going after real interstate organized crime – the govt promoted the idea, through ONDCP announcements and attendant propaganda blitz, that physicians treating pain patients were the primary cause of what they have hyped as this years moral panic, prescription drug abuse.

So they prioritized going after the docs instead of the criminals, and for every doc they take out, entire communities of patients have their lives turned upside down, terrified that the medications they need to function and survive in the world have been suddenly and brutally taken from them by agents of their government. Meanwhile most other primary care docs in the community, now understandably scared that what happened to their colleagues for treating these patients could happen to them, do everything they can to shun these now dangerous patients, patients who need pain medication.

The article promotes the usual inaccuracies about substance abuse and pain treatment:

“Most people who abuse pain medication start out with a legitimate problem and seek appropriate help.”

In fact overwhelmingly chronic pain patients on properly prescribed opioids in adequate dosage rarely develop addiction (DSM ’substance dependence’) and most substance abusers in chronic pain treatment had pre-existing drug and alcohol problems.

The article and also provides an example of how ‘the new academic opiophobia’ (see pages 34-37 of PRN’s State Tort Claim vs WA State), which is mostly a misinterpretation of the medical literature, is used here, obliquely, to suggest that it is perhaps a good thing that chronic pain patients be abruptly cleaved from their treating physicians -sheesh!-:

“New research is showing that long-term use of controlled pain medication might actually increase pain sensitivity over time, and non-steroidal, anti-inflammatory drugs could be more useful.” [and will for sure be far, far more toxic - the great leap backward ..alex..]

These entire communities of patients who have and will predictably suffer terribly are not offered some rational public health policy to establish safe harbors and assist abandoned patients find needed medical care. No, instead these patients have their medical records seized and are left to fend for themselves against medical and insurance whose interests are aligned in not providing care – the docs are afraid, and the insurers smell profit in patients off meds. All eyes remain entranced on the policeman’s movie of doctor-shopping patients and doctors who should have known. The abandoned legitimate pain patients just get sicker and sicker, become invisible, easy to forget about.

You reap what you sow, and we are reaping the whirlwind of a drug war increasingly focused against sick people and their physicians.

..alex…

---

Source of Pain Pill Dries Up
Blackford, Kentucky Herald-Leader, 2008-068-06

Patients are flooding into doctors’ offices and emergency rooms around Lexington, seeking a replacement for two local doctors suspended for overprescribing pain medications.

The state’s disciplinary action against Dr. Charles Grigsby and Dr. James Heaphy appears to have dried up an important source of prescription drugs for those who need them — and for those who might simply be addicted.

”I’ve got people going through withdrawal in my waiting room,“ said Dr. Ben Huneycutt, who recently opened a family practice on Third Street.

In the past two weeks, he’s gone from seeing four to five patients a day to two an hour, most of them looking for new prescriptions, he said.

Local emergency rooms are also affected

St. Joseph Hospital’s emergency room has seen a ”significant“ increase in patients with chronic pain problems in the past few weeks, said spokesman Jeff Murphy. Good Samaritan Hospital, now owned by the University of Kentucky hospital system, has been seeing several patients a day with withdrawal symptoms, said spokeswoman Mary Margaret Colliver. Central Baptist Hospital is also referring people to treatment centers.

The Fayette County Health Department has received ”numerous calls from people wanting appointments because their regular doctor cannot practice medicine,“ said spokesman Kevin Hall. However, the health department doesn’t offer pain management services, nor does it manage patients requiring withdrawal from controlled substances.

Late last month, the Kentucky Medical Licensure Board suspended Grigsby from prescribing and suspended Heaphy’s medical license. Both doctors were sanctioned for repeatedly prescribing drugs meant for short-term use for pain, prescriptions for combinations of drugs favored by people who abuse or divert such substances. Investigators concluded that both doctors constituted a danger to the welfare of their patients.

They will appear in formal hearings before the licensure board later in the year.

Kentucky has some of the worst prescription drug problems in the country. Between 2002 and 2004, the state had the highest percentage of people using prescription drugs for non-medical reasons, about 8 percent.

Between 12 and 15 percent of all grievances filed with the licensure board are prescription issues.

Robert Walker, a professor and researcher at UK’s Center for Drug and Alcohol Abuse, says the recent reports of patients seeking prescriptions ”make sense. Any time you have people who have established a pattern of obtaining opiate medications from sources like that and the source dries up, you’re going to find people desperate to find a prescription.“

Lexington police Detective William Goldey, of the prescription fraud unit, says he expects to see an increase in doctor-shopping in the region. More desperate patients might try to steal prescription pads or get pain medication, and in the worst-case scenario, resort to robbery.

”It’s inevitable,“ Goldey said. ”Prescription drugs are becoming the No. 1 drug of choice.“

The two cases in Lexington show just how complicated the issue is, said Van Ingram, branch manager of compliance at the Office of Drug Control Policy in Frankfort. ”We want patients to get the things they need, but we don’t want them to abuse it,“ he said.

Most people who abuse pain medication start out with a legitimate problem and seek appropriate help. That’s why it often takes so long to investigate doctors.

Grigsby and Heaphy were investigated by the licensure board after grievances were reported to the Cabinet of Health and Family Services. Neither doctor returned phone calls from the Herald-Leader.

”It’s important to recognize the board wants doctors giving appropriate pain medications to patients who need them,“ said Lloyd Vest, the licensure board’s general counsel. ”Each case is different and each case warrants a different response.“

Prescriptions only

Grigsby and Heaphy are both longtime internal medicine specialists in the area. The charges against Heaphy were more severe, including altering patients’ charts and a lack of basic care to his patients outside of pain prescriptions.

Debra Milton of Lexington was one of his patients. In 21/2 years, she said, ”he never checked my blood pressure, he never took my temperature, never weighed me, nothing. All he did was give me medicine for my back and neck and anxiety.“

Heaphy prescribed Lortab and Xanax for Milton for injuries received in a 2000 car wreck. ”I have chronic pain, and I need the medications,“ she said.

She’s now looking for another doctor, and said she tried Grigsby’s office, but was told she would have to pay $348 just to come in. She does not have health insurance.

Heaphy — who, according to Fayette County property records, owns a 102-acre horse farm on Old Frankfort Pike assessed at $3.4 million — also practiced in Frankfort. That’s where Louise Schraeder saw him for the past 10 years. ”He’s been a good doctor to me and never been one to push medication,“ she said, although he did prescribe some controlled substances to her. ”There had been some concerns I’d voiced to him about some of the people I’d seen his office.“

Schraeder said Heaphy worked with her to pay for her treatment and would give her free samples of things such as blood pressure medication. Because of that, she said, ”I’m sure there will be physicians reluctant to take his patients.“

Pain specialists needed

UK’s Robert Walker said one of the complications to the prescription drug puzzle is that in Kentucky, there aren’t many doctors trained in the field of pain management. New research is showing that long-term use of controlled pain medication might actually increase pain sensitivity over time, and non-steroidal, anti-inflammatory drugs could be more useful.

”You want a well-trained pain specialist prescribing these things, not necessarily a primary care doctor who has 10 minutes to spend with a patient,“ Walker said. ”There’s a lot of personal history you need to collect before prescribing an opiate, like a history of addiction or alcohol problems. There are people who are partly addicted, partly in chronic pain ­— and making that discrimination takes time.“

Meanwhile, back on Third Street, Huneycutt says he’s still seeing a portion of Grigsby and Heaphy’s former patients, trying to tell them he won’t just prescribe medications, while he tries to diagnose some of the underlying problems they have. ”It’s good these guys were busted,“ he said, ”but when you yank both their licenses at the same time, you create a big problem.“

[END]