By Tom Kisken, Ventura County Star, Calif.
Pain patients understand why California’s attorney general says he needs to raise $3.5 million to stop addicts and drug dealers who use doctors to stockpile Vicodin and OxyContin.
Abuse of prescription medicine is rampant in part because chronic pain can put your head in a vise and reduce you to a lump of flesh unable to do anything but lie on a sofa, said Bob Ramos of Santa Paula, whose spine has been surgically fused. It can feel as if “someone was grabbing your ligaments and pulling them out of your back,” said Terry Kierzek of Agoura Hills, who had a cyst on his spine.
Largely misunderstood and, according to some experts, neglected by the healthcare community, pain can drive dependence on prescription drugs. The medication is highly addictive, doesn’t address the source of pain but clouds the sear and throb that, as Mary Schirm of Thousand Oaks put it, “will drive a person insane.”
“Do I understand the need for medication? The need to stockpile? The need to gather drugs? Absolutely, 100 percent,” said Schirm, who has massive headaches but fights the temptation to overmedicate.
Edmund G. Brown Jr., the former governor and presidential candidate who is now California’s top cop, wants to implement an online database that would track prescriptions for addictive drugs. While a patient waited, pharmacies and doctors could check the database and make sure the person isn’t doctor-shopping — collecting a half-dozen prescriptions from different doctors for painkillers.
“The motive is to allow doctors not to unwittingly overprescribe, or if they illegally do it, we want to go after them,” said Brown, who hopes to implement the system next year if partner groups can raise the money.
The magnitude of the problem is hard to diagnose, though state officials cite a 2007 report from the Coalition Against Insurance Fraud. It suggests insurance companies are billed nearly $73 billion a year for prescription drugs that are abused or resold.
Ventura County prosecutors filed charges Tuesday against Dr. Bernard Bass of North Hollywood for allegedly conspiring to provide patients with OxyContin and hydrocodone after surrendering his license to prescribe. Prosecutors say they’re investigating the possibility of a connection between Bass’ prescriptions and the deaths of six of his patients from Ventura County.
‘A problem like any other drug is’
Dr. Michael Huff, an Oxnard pain specialist and once the president of the Ventura County Medical Association, was charged in 2003 with 55 counts of illegal distribution in a case ignited by overdose deaths involving OxyContin. Huff pleaded guilty to one count in 2006 and was sentenced to more than three years in prison.
“It’s a problem like any other drug is,” said sheriff’s narcotics Detective Victor Fazio. “We’re looking at the abuse and the illicit use and resale of prescription drugs just the same as we look at cocaine, methamphetamine and marijuana.”
Fazio said he believes doctors are conned by as many as 10 percent of their pain patients into providing unneeded drugs. Because the doctors can’t measure pain, they take patients at their word.
“Any good doctor is going to get duped a fair percentage of time,” he said. “It’s when they have a blind indifference to what’s going on in their practice and they become known as a source of supply for drug dealers in the street, that’s when we get involved.”
Dr. Kamyar Assil, a specialist in Thousand Oaks, said pain care focuses on much more than medication and includes procedures aimed directly at the source of pain.
When Assil does prescribe painkillers, he demands his patients sign a contract agreeing to get medication only from one doctor and one pharmacy. He said very few people challenge that system. But a year ago, Assil called deputies to his waiting room to confront a patient believed to be forging prescriptions for Vicodin.
Not everybody is as vigilant.
“We know there are certain doctors who tend to collect patients who pay cash and get huge prescriptions of OxyContin, etc.,” Assil said. “Just in our area, within a 20- to 30-mile radius in the last eight or nine years, two or three doctors have lost their licenses.”
Dr. William Coburn of Thousand Oaks surrendered his license after being arrested three years ago on suspicion of trading Xanax and Norco for a gun. Prosecutors dropped the narcotics accusation, and Coburn pleaded no contest to two misdemeanor weapon counts.
Pain specialists say the arrests have a numbing effect on primary care doctors.
“I think that kind of shook everybody,” said Dr. Estela Diesfeld of Ventura, referring to Huff. “Immediately, you saw a lot of doctors refusing to write any (addictive) pain relievers or any tranquilizers.”
The reluctance mirrors a societal misunderstanding of pain management, said U.S. Rep. Lois Capps, D-Santa Barbara. The registered nurse is co-sponsoring a pain care bill aimed at increasing research, community education and training of healthcare professionals.
People don’t understand their pain can be treated by therapy and other procedures, Capps said. They stockpile drugs because they don’t see any alternatives.
“Prescription drug fraud comes from a lack of good healthcare,” she said.
When the pain in his head and neck is at its radiating worst, Bob Ramos can’t do anything except rest or take the Vicodin that is used only for what he calls breakthrough attacks. He’s had three neck surgeries and traces his pain to high school football and a car crash when he was 22.
Brown’s plan praised
Like many pain patients, he worries about becoming too reliant on pain medication and no longer takes OxyContin because it’s too addictive. He praised Brown’s plan for an online prescription database.
“I think that’s great because there’s abuse out there,” he said, thinking of the people who do whatever they can to get painkillers. “You’re playing with a loaded gun.”
The state’s database already exists, made from mandatory prescription reports filed by doctors and pharmacies. But when doctors currently make requests for information, it can take three weeks to get a response, meaning the information is of little value.
An online system that provides instant access would give doctors and pharmacies more control, said Dr. Scott Fishman, a medical school professor at UC Davis and president of the American Pain Foundation. It would empower doctors to prescribe drugs without worrying about being duped.
Diesfeld of Ventura worries the database may have gaps, meaning doctors and pharmacies could still make mistakes. Fishman worries doctors could see the plan as an attempt by law enforcement to catch doctors who make a mistake.
Brown brusquely rejects the criticism, worrying only about the money needed to create the system. The state’s $15 billion deficit means the $3.5 million will have to come from outside sources. That fundraising drive is being led by the Troy and Alana Pack Foundation, named for children killed by a driver who was using prescription medication that came from multiple doctors.
The attorney general sees the database as a way to make prescriptions transparent. “This to me is a no-brainer,” he said, “and if there are abuses, we will crack down on them.”
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