The Wonders and Horrors of Prescription Pain Killers

Few of us appreciate the fact that pain serves a useful purpose in our lives. Most often it tells us when something is going wrong with our bodies. A toothache is a good indicator that the tooth has a cavity or some other problem, while an earache might signal an ear infection. All we know at the time is we want to get rid of the pain as soon as possible.
There are numerous drugs – over the counter and prescription, to combat the pain while the underlying cause of the pain is treated (when possible). If used correctly, these drugs can do wonders. If used incorrectly, these drugs, particularly prescription pain killers, can control lives, and even snuff them out.
            With the recent death of Michael Jackson, much has been in the news about the abuse of prescription painkillers. Although Jackson’s cause of death has yet to be determined, the media is filled with stories about Jackson’s use and apparent abuse of prescription painkillers.  Whether the news stories are true or not, and whether his death is linked to these drugs, the one thing his death has done is bring the topic of the misuse of painkillers and other prescription drugs into the spotlight.
Addiction to pain killers is not limited to superstars. The scourge is prevalent in every section of Vermont, including the Northeast Kingdom.
            “It’s a problem everywhere,” Dr. Paul Newton said. “It’s a very real problem here.”  Attempts are being made to curtail prescription drug abuse but it’s a difficult battle to fight.  Dr. Newton is the medical director of the Emergency Department (ED) at North Country Hospital in Newport.
            Doctors, including in the ED, often find themselves on the frontlines of painkiller abuse. It is not rare for people to show up at the ED faking pain to feed a drug habit or to get a prescription so they can resell the drugs to make money.
            The medical community does everything possible to combat prescription fraud, Dr. Newton said. However, he said it is a difficult job. While there is a simple test to determine whether a person has high blood pressure, there is no test to determine whether a person is truly in pain. Instead the medical staff looks for indicators of drug addiction and drug seeking behavior. One sign of a possible drug seeker is they come into the ED, or into their doctor’s office, and they already know what drug they need. They have no interest in non-narcotic substitutes. Unfortunately, doctors often find themselves in a Catch 22. If they prescribe too many narcotics they are accused of being pill pushers, and if they withhold pain pills they are often seen as uncaring.
The Journal of Law, Medicine, and Ethics has compiled the following list of characteristics that might serve as an indicator whether a person needs painkillers or if their physical need is as strong as their addiction to the drugs.

Pain Patients

1.         Able to control use of the medications
2.         Medications improve the quality of the patient’s life
3.         Will want to decrease medication if side effects are present or troublesome
4.         Continued concern about the physical problem that causes the pain
5.         Follows the agreement for the use of the opioids
6.         Frequently has medicines left over from previous visit

Addicts

1.         Out of control with medicines
2.         Medications cause decrease in the quality of the patient’s life
3.         Continues or increases medication despite side effects
4.         Unaware or in denial of any problems related to the pain
5.         Does not follow the agreement for use of the opioids
6.         Has no medication left over, loses prescription, or medicines, and always has a “story”
7.         Alters route of administration
8.         Forges prescriptions
9.         Steals medicines

Thanks to a data base compiled by the Vermont Department of Health, physicians have a new tool to identify people who might be attempting to fraudulently obtain controlled drugs. The data base came online in May. It allows them to see if another doctor anywhere in Vermont has recently prescribed the patient a controlled drug - primarily narcotics and benzodiazepines, such as Valium and Ativan. Dr. Newton said the data base is a great new resource, one that is certainly making their job easier at identifying drug seekers. It should also help to stem the tide of the number of prescription drugs being sold on the illegal market.
The medical staff in the ED and other medical establishments are not the only ones who are aware of the problem with the abuse of controlled drugs. Paul Duquette, Chief of the Newport City Police Department, who for several years worked as an undercover officer with the state’s drug task force, is all too familiar with the problem.
            “It’s very much a problem in the area,” Duquette said. He’d like to say that the problem is getting better, considering the horrors of prescription drug abuse repeatedly in the news, but he said that isn’t the case. “It’s not getting any better.” Among the most abused drugs are Percocet, Oxycodone, and Vicodin.
            Contrary to what some people might think, not all people addicted to painkillers and other narcotics are stereotypical drug addicts living on the fringes of society, the chief said. Instead they come from all walks of life and from every social economic class.
            “There are a lot of good people hooked on painkillers,” Duquette said. Many of them began using painkillers innocently enough to relieve pain often caused by an injury, but without realizing it was happening, they became addicted to the drugs that were prescribed to help them.
            Addiction can cause some people to do things that they would have never otherwise done before coming under the grip of addiction. When addicts can no longer get painkillers from their doctors, many become desperate. Some finally face up to their addiction and seek help, but many others begin to shop around, going to other doctors in an attempt to convince them they are in pain, when in reality they are trying to feed their addiction.
“There are a lot of doctor shoppers around here,” Duquette said. Addicts and/or dealers go from doctor to doctor in an attempt to fraudulently obtain painkillers. While some of the addicts use those fraudulently obtained drugs for their own use, other people sell them on the black market.   
 “Some people are selling drugs legally prescribed to them and are making big money,” Duquette said.
Once addicts are no longer able to convince doctors to prescribe these drugs, they turn to the illegal market. Duquette emphasized that attempting to obtain drugs from a doctor fraudulently and selling them or buying painkillers on the black market is illegal.
Black-market painkillers come from a wide variety of sources, Duquette said.  There are people living in the area who are trafficking painkillers, such as Oxycontin, into the area from other parts of the state and beyond, then selling the drug here. Some of the sources, however, are homegrown. There are some local people who have been prescribed narcotics either out of medical necessity, or through fraudulent claims of pain, who are selling the painkillers on the black-market. Users can often sell a legally obtained painkiller for several times more than its market value, he said.
Not all the addicts the chief runs into, though, became addicted after legitimate use. Instead, they obtained them illegally, not for pain, but to get high. This is often the scenario for young people who are experimenting with drugs. A third group of people who frequently abuse painkillers are heroin users.  When the area’s heroin supply begins to dry up, Duquette said some of the users will turn to the painkillers to serve as a temporary replacement for the heroin until they can find another source. Some will venture to medical offices or to the hospital with fraudulent claims of severe pain in an attempt to obtain narcotic containing painkillers.
The chief praised many of the doctors in their attempt to identify drug seekers and not prescribe them narcotics. He said the medical establishment has come a long way in recent years in this effort. “Doctors in the area are making leaps and bounds,” he said, noting that his department has a great working relationship with North Country.
 Looking back over his years as a doctor, Dr. Newton said he has seen drug seekers come up with many unique excuses why they need painkillers. Although rare, some addicts come right out and admit they are addicted to either painkillers or heroin and they need the doctors to prescribe them painkillers to prevent them from having withdrawals. That isn’t going to happen, Dr. Newton said. Doctors can’t prescribe narcotics for that reason. However, he did say he and other physicians do want to help addicts who are willing to help themselves. They refer them to various drug addiction resources.
Dr. Newton noted there is nothing easy about overcoming drug addiction, whether it is prescription drugs or heroin. “Narcotic withdrawals feel horrible,” he said. “You are going to go through a lot of pain. You might even feel like you’re going to die. That’s why some addicts put off quitting or don’t quit. They don’t want to go through that.” However, he said there are prescription drugs available through one’s physician that can alleviate many of the symptoms.”  And he said the benefits of overcoming one’s addiction far outweigh the pain of withdrawal.
By Scott Wheeler/North Country Health System

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