A Munster family physician at the Prestige Clinic on Ridge Road, was recently indicted for allegedly overprescribing opioid pain pills or as the Chicago Tribune article states, he was indicted on “four counts of selling, distributing or dispensing hydrocodone.”  The 2 articles I read go on to say that he prescribed Norco (Hydrocodone) without conducting appropriate and sometimes even cursory medical examinations.

The article seems to suggest that he may have been running a prescription mill. Why do I say this?  Well, if a doctor writes 6000 prescriptions for pain pills over an 8 month time period that’s 750 prescriptions in a month.  Or about 32 scripts a day.  If one is writing that many prescriptions for pain pills in a day that must be all that the doctor is doing.  But, aren’t family doctors supposed to take care of high blood pressure, diabetes, upper respiratory infections, CHF, etc.  If so when could they have time to provide primary care if their schedule has 32 pain pill requiring patients on it every day??  I am a pain specialist and I only see about 20 chronic pain patients every day.  Our whole practice, that includes 5 MD’s and 3 Nurse practitioners, does not in TOTAL write anywhere near 32 scripts for opioids on a daily basis for all 8 providers!

I suspect that the Prosecutor/Attorney for The Northern District of Indiana, Thomas Kirsch, also did the math and suspected that something fishy may have been going on at Prestige Clinic.

The fact is that this is serious stuff and opioid deaths are spreading faster than ever.  The opioid epidemic is becoming increasingly more fatal.

Courtesy – CDC – Vital Statistics

There has been a tremendous increase in drug overdose deaths from 1980 to 2016, from about 5,000 per year (1980) to over 65,000 drug overdose deaths in 2016.

Upwards of 65,000 people died from drug overdose deaths in the US in 2016.

This represents at least a 22% increase over 2015.  This is possibly the leading cause of death for Americans under 50 years old. Currently over 2M heroin addicted people in the US probably got their start from prescription pain pills.  Law enforcement’s crackdown on the use of prescription opioids has led to a spike in heroin use. Sadly, the heroin obtained on the street is more and more being laced with Fentanyl or Carfentanil. This will kill most of the heroin users who think that they are getting their usual hit and BAM they get a hit of heroin laced with the Carfentanil and their dead!

Regulations that doctors are supposed to follow require that we be overcautious.

We are supposed to be on the lookout for fraud by using urine drug tests, medication contracts, the INSPECT (Indiana Scheduled Prescription Electronic Collection & Tracking Program) and other measures to identify patients who are using opioids inappropriately or potentially diverting opioids for sale or inappropriate use.  Part of the decision process required to write an opioid prescription includes taking a proper history from the patient, performing a proper physical exam and evaluating any special tests like MRI scans, etc. If after all this is done, we determine that the patient has legitimate pain, we MAY consider writing an opioid prescription.

Often we still don’t. We offer other non-opioid options like NSAIDS, physical therapy, spinal injections, advanced technologies, etc. etc. If an office were writing 32 prescriptions a day for opioids it doesn’t seem likely that they were doing much else.

Not surprisingly, patients with legitimate need for opioids are frustrated by all the new obstacles that they have faced over the last few years.  They become downright angry at times when we question their need for the opioids.  But only rarely does a patient who comes to our Northwest Indiana offices get that angry if they have legitimate pain.  They are in search of real solutions. And just using opioids in a void without other options is rarely a good solution.

Nowadays if a patient has such severe pain that they need opioids then they are considered more risky patients and such patients should be referred to a pain specialist. This is not simply my opinion. This is what the State of Indiana advises in the Physician Toolkit that prescribers are advised to follow. (It is available on the website at Bitterpill.IN.gov). Why should these patients be seen by pain specialists? Because we are better equipped to offer alternative treatments. Because we can better screen for addiction. And when necessary, we can prescribe opioids safely.

Per Google maps, the distance from Prestige Clinic to our MISS office on Calumet Avenue is just 0.8 miles.  With so many patients apparently in such pain that they needed prescription opioids, it is unfortunate that we did not have the opportunity to help them. And certainly, our practice would be happy to accept referrals from area doctors with patients who could benefit from referral to pain management.

Let me be clear, pain specialists are not any more excited about writing opioid prescriptions than any other doctor.  We accept this responsibility because we want patients with legitimate pain to be well taken care of.  We do so at great risk to our own personal safety and the safety of our employees.  We are sadly reminded of what happened to my friend, Dr. Todd Graham of South Bend, Indiana.  As many of you may know, he was brutally murdered in June 2017 by his patient’s husband that demanded that he write a prescription for opioids. He refused and his family will be forever reminded of his bravery. This is the epitome of workplace violence.

According to the April 2016 issue New England Journal of Medicine, “Workplace violence is rampant, underreported and under-recognized in the healthcare workplace.”  This may include verbal abuse, intimidation, aggressive demands, and in the worst-case scenario, homicide as happened near South Bend, Indiana just this past summer.  Some statistics show that 75% of workplace assaults happen in the healthcare setting.  So, the next time someone is abusive or overly loud and aggressive in a medical office, don’t be surprised if the police are called in. The increasingly fatal opioid epidemic in America has taken the lives of doctors and nurses also, and all they were trying to do was help patients.

It is not fair or appropriate that they should be verbally abused because they made the determination that opioids were not medically necessary for a particular patient.  But sadly, this abuse happens every day in America.  These brave and honorable health care workers are following the rules and their hearts and caring for patients the best that they can. Doctors who write excessive opioid prescriptions each day may have other motivations.

—

By Shaun Kondamuri, MD