“I’m going to kill you!” the patient screamed at the doctor after telling him “f*** you!” for his refusal to write a prescription for 270 Oxycontin. The patient had taken the “Oxy Express” but came back to North Carolina to fill her prescription – a stupid move since narcotics prescriptions can’t be filled across state lines – and then visited his office and demanded her family doctor rewrite it. Her doctor explained the situation and offered to refer her to a clinic that specialized in pain management, but she refused. She wanted her “f***ing pills” and threatened to sue him unless he wrote the script. He didn’t budge, and the outburst followed in front of several patients and staff.
Over the years he has seen a rising in prescription drug abuse among his patients making otherwise normal people who have suffered injury into pill-seeking addicts. “Patients will bounce from one doctor to another until they find one who will write the scripts. If they can’t find one locally, there is always the Internet, a friend they know who will sell them a few tablets, or the ‘Oxy Express’.”
What troubles him is that there isn’t the stigma with prescription drug abuse that there is with alcohol or illicit drugs. “People take vicodin and think it’s safe because it’s legal and they got it from their doctor. But then they start finishing their prescriptions early. Like all addicts they slide into addiction.”
The problem, as the doctor explains it, was that we had gone from one extreme to another. “Years ago people were just told to suck it up when they were in pain,” he says. “There wasn’t much pain medication out there beyond morphine and a few benzos. Now we’ve gone to the opposite extreme where we treat every twinge and ache with painkillers.” He believes that people’s understanding of pain had changed, and that the overuse of painkillers was making the treatment of pain worse. “Pain is your body telling you to take it easy,” he says. “By dulling it with drugs you risk making the injury worse.”
The issue is more complex with what people call “chronic pain”. “Not all pain disappears within a few days or weeks,” he says. “But pain rarely lasts forever either. It may take months or even years for the underlying condition causing the pain to resolve.” Because pain is part of a complex feedback system between the mind and body, it is possible that treating it as a chronic condition with drugs may result in a situation where the body has healed completely but the mind still perceives pain. “The pain is real – it’s not in the patient’s imagination,” he says, “but the painkillers disconnected the pain from the event that caused it in the first place. It exists on its own, and therefore becomes a true chronic condition.”
Back pain is real and may never resolve, condemning the patient to a life-time of pain. But pumping him full of narcotics debilitates him just as much as the pain does. “We’re in the Dark Ages when it comes to handling pain,” he says. “We cannot reliably remove pain without impacting a person’s daily activities.” Some pain management clinics are experimenting with hypnosis and bio-feedback as well as acupuncture in order to find pain relief that doesn’t turn people into zombies.
But the doctor wasn’t hopeful. “Treating these patients isn’t easy which is why I don’t like doing it,” he says. He refers as many of his patients to pain management but worries that all he is doing is passing along the problem to someone else. Worse he is developing concerns that some of these clinics are just money-making pill dispensaries, leaving Society to suffer the consequences of a growing legion of addicts.
A few years ago three of his patients were in a car accident. A man, his wife and their 10 year old son were cruising at high speed before the car slammed into a box truck…. All three died instantly. Pill bottles were found on the car’s floor, and toxicology found the dad was high on painkillers. None of the bottles had his doctor’s name on them, which gave him a measure of relief. One of the first respondents on the scene – another one of his patients – was haunted by the sight of the boy’s limp head hanging upside down in the back of the car. He was a strong middle-aged man who had seen a lot over the years as a volunteer firefighter, but what he saw that night still haunts him.
The doctor remembers that boy whenever one of these junkies come seeking drugs, and it makes it much easier for him to keep his prescription pad in his pocket.
The above is a composite based on a series of conversations I’ve held with health care providers over the past two years. Both the addict’s rant and the accident occurred as described. SK
The Grouch At Right Truth, an ER physician, lists 11 warning signs of a drug seeker. My favorite:
4. They frequently present with illnesses that are hard to objectively diagnose. A couple of favorites are headaches and back pain. Now many people present with legitimate causes of headache and back pain and some of those can in fact be life threatening. Herein lies the problem. Sometimes the bullsh*t train ride can be long and expensive as we run many, sometimes costly tests in an attempt to separate the sheep from the goats as well as protect ourselves from lawyers.
Another reason the Wife should have been a plumber.