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Abuse of prescription painkillers spurs move for online database
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Photos by Jason Redmond / Star staff Dr. Kamyar Assil, a pain management specialist in Thousand Oaks, injects an epidural into the back of a patient at an outpatient surgical center. He says his pain care focuses on more than medication.
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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."
Posted by ecarson1958 on July 9, 2008 at 7:47 a.m. (Suggest removal)
Having a medical condition and debilitating pain is the result, sometimes the only thing a person can think of is pain relief. But, all patients who suffer with pain at some point must make a choice of either finding an outlet for the pain, or they all will become addicted to medicine. Lower back pain is incidious. A book I read titled "Mind over back pain," helped me understand the difference between true physical pain and the manifestation of pain by the brain. When we are overstressed our brain will take an emotional pain or problem and then manifest itself into a physical pain. Finding out exactly what is bothering a person mentally, emotionally can actually relieve the physical pain. It is an excellent book worth checking into if you suffer from chronic pain.
Posted by turbochrg01 on July 9, 2008 at 7:49 a.m. (Suggest removal)
I have had six back surgeries and yes there are people who abuse drugs. I use to work in a hospital and every couple of weeks we would see "drug seekers". I also have signed a contract with my Dr. I think people are uneducated about the side effects. People also allow the pain level to get to high 10 being highest on the scale and so they take more then they should and then start a nasty habit of taking more and more to help control the pain. I have to walk everyday for the rest of my life and was told I would NEVER work again. I work two and three jobs. Sometimes it is mind over matter. It's like Diabetes you can control it and your life or you can let it control your life. At one of my jobs I work in a pharmacy and we do call around to other pharmacy's if we feel the patient is stockpiling. The ones that are hard to follow are the ones who pay cash. I am all for it. Alot of Dr's quit carring these types of drugs in there office because people would break in and steel them. Good luck to those who have a problem, get some help! Start to think positive and take control of your own life. Start out slow and build from there. Call a friend or pastor, anyone who can give you a shoulder to cry on.
Posted by NancyB on July 9, 2008 at 9:14 a.m. (Suggest removal)
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Posted by bugmenot on July 9, 2008 at 10:28 a.m. (Suggest removal)
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Posted by Fred on July 9, 2008 at 11:22 a.m. (Suggest removal)
Getting these drugs is easy. Go to the ER. The taxpayers pick up the tab, and you can ER hop all you want (e.g. multiple ER's) because they cant talk to one another about you cause of HIPAA. All of the patients immediately work the system, bother the docs to give them more and more, some then even sell them.
Its a beautiful thing.
Posted by patticakepatti on July 9, 2008 at 1 p.m. (Suggest removal)
Good article and so very true. There are doctors out there that mail the narcotic pain pills to you and you only have to see them every 2 months!!!!!
Doctors should be held accountable. It's much more cost effective for them to say, "yes, go ahead and fill it," rather than, "come in and see me before you get anymore!!!!"
Posted by medaisy on July 9, 2008 at 4:27 p.m. (Suggest removal)
Not until you stand at the foot of your own child's hospital bed praying that they do not die from an overdose can you comprehend the severity of drug abuse. I thought those things only happened to other people; not to anyone in my family.
The posting of those in the arts who have died from drug overuse says it all. They had so much going for them and drug abuse took it all in an instant. For what?
My doctor has made it a policy "no RX refills unless you make an appointment to see the doctor. NO EXCEPTIONS". That's the way it should be.
Chronic pain is debilitating. I have had several back surgeries. I read every single piece of information I can find on any new methods or medications being offered for chronic pain management. I avoid daily use of pain meds unless I am about to have surgery or post surgery. I know that the least I take; the better off I will be. In the end; I am responsible for what I put in my body, not the doctor.
Posted by daisy7859 on July 9, 2008 at 4:52 p.m. (Suggest removal)
I hope this online prescription database goes into effect, to protect doctors, pharmacists and patients from this growing epidemic of prescription drug addiction.
This database will protect those in the medical field who just want to help their patients. But this shouldn't be the only answer to this problem.
Doctor's should exhaust efforts to physical therapy, diet & exercise as well as alternative means to treat pain. Giving patients hundreds of pills are not going to treat the pain, people need to get moving.
Maybe if this database goes into effect, pharmacists can start denying prescriptions filled and paid for by health insurance companies and that leftover money can go to some good, like helping those of us who have no health insurance.
These addicts go out, get many prescriptions from different doctors, go to different pharmacies and get thousands of pills to take for themselves and sell them. They make a profit because either their health insurance plan pays for them or their worker's comp pays for them.
If doctor's are prescribing painkillers months and months at a time, why not try sending those patients to drug rehabilitation centers, THEY ARE ADDICTED.
Its a shame that many doctors are not in trouble, serving time just to help out their patients they care for.
P.S. I don't have health insurance, yet I pay my taxes. Thank you to all those drug addicts who reap the benefits of people like me who cannot afford to go to the doctor. Thank you for wasting our money to feed your measly habit.
Posted by coastalslinger on July 9, 2008 at 7:34 p.m. (Suggest removal)
Most people who go on pain medication do not do it with the hope they will get addicted. They just want relief.
A red flag should go up when a physician is filling prescriptions over and over again for the same drug, or the patient saying the dose is not effective anymore.
This is a sad situation. Working in a hospital, I have seen people in massive pain. No amount of therapy, or holistic medicine is going to help them. Unfortunately, many pain meds are addictive, and you never know who this will affect.
I don't know the answer. I do know that some doctors should be held accountable for the patient they keep giving drugs to who are obviously addicted. And a data base to identify "drug shoppers" is a start.
There is no easy fix for this.
Posted by myOpenyun on July 9, 2008 at 11:01 p.m. (Suggest removal)
It must be that having an addictive personality plays a part in this! I have had surgeries and have taken oxy, vicodin,and stonger meds for pain. I remember being hooked to the morphin machine and using it at every hr. when I could. I also know that when I came off that machine I had cold sweats, pain in my finger tips and toes and teeth chattering that was very painful. I DIDNT LIKE IT! With that said I also know that I did like the feeling of the pain killer as it released itself into my body as I felt nothing and everything looked great! Yes it was cool and felt great but I also understood what they were being used for. It was mind over matter! I could have continued to ask for a refill whether I needed it or not,, the door was open for me if I wanted as the Drs. were only trying to help my pain and me. People need to realize that meds are for a moment not a life time. When they abuse the drugs they abuse themselves and the system that is put in place to help them. I can understand the reasoning for the love of the feeling but I cant understand the love of ruining ones life. Drs. should realize when a patient doesn't need the pills anymore and send them into a new direction of theraphy and self help. It is up to us and us alone to take care of our bodies and do what is right for own person. But Dr.s have the power to stop the abuse and work harder at helping their patients without a pen!
Posted by llopezsm on July 10, 2008 at 7:44 a.m. (Suggest removal)
I am in chronic pain daily, having multipule health problems. I have been prescribed several pain meds over the years. Do they mask the pain? Yes of course they do. Relief for intense pain for awhile, YES. Nobody is forcing me to take more pills. It is mind over matter. Living like this is horrible.YOU control what YOU put in your mouth.Going to the ER is my last resort. The hospitals are connected to each other, so they can find out what you have been taking. You should also carry a updated list of meds if you do need to go to the ER.I am a taxpayer.
I get a bill from the ER,and PAY for it! Pain management is something we can all learn from. medaisy said it right : I am responsible for what I put in my body,not the doctors.But of course people who abuse them, hurt the ones that really need them for awhile, if YOU continue to use them,without tapering off, it is YOUR own fault!
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