By Scott Wheeler

Community Relations Department

North Country Hospital and Health System

From his dealings with people caught with, or buying, black-market prescription painkillers, a portion of them became addicted to them after obtaining them from doctors through presumably legal means. Once addicted, these people are often forced to feed their habit by buying the painkillers on the illegal market. Other users turn to painkillers not to mask pain, but to get high. They, too, often find themselves addicted to the drug. 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 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 doctor offices or to the hospital with fraudulent claims of severe pain in an attempt to obtain narcotic containing painkillers.

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. He emphasized that selling or buying painkillers to those not prescribed is illegal.

“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. Once obtained, they either use the drugs themselves, or sell them to others. Ideally it would be good if law enforcement and doctors could work together to identify suspected drug abusers, but the chief said federal health and privacy regulations prevent health officials and officers from forging this bond that would allow them to share information.

Doctors becoming better educated about prescription painkiller addiction

There was a day when if a person went into an emergency department or into a doctor’s office complaining of pain, they would be prescribed painkillers with no discussion about the addictive side effect. Dr. Ladak, said. That isn’t the case anymore. When patients come in with a history of chronic pain or injury, doctors work to identify patients that they think are abusing painkillers. The doctors and other medical professionals affiliated with North Country Hospital look for signs of drug addiction and behavior associated with drug seeking.

“Doctors have to ask themselves, is this person looking for pain relief, or has his or her use crossed over in the realm of addiction?” Dr. Ladak said. That’s not an easy task. People looking for drugs to feed a habit can come up with some pretty convincing reasons why they need the drug, she said. The standard story line of an addict is that their pain is so unbearable that they need painkillers to control it. Then there are the people who already have a prescription for painkillers, but complain to their doctor or emergency room medical staff that they have lost their pills and need the doctor to prescribe more. It’s up to the doctors to decide whether the person is telling the truth or whether they’re trying to obtain extra painkillers, either to use themselves or to sell.

“There isn’t a story we haven’t heard,” Dr. Ladak said. Some people simply say they lost their painkillers, while others devise much more colorful stories. More than one person has walked into the hospital and insisted that their dog had eaten their medicine, a spin off of the childhood excuse - the dog ate my homework. Some stories are a bit more colorful. For example, she recalled a man who told her that he’d lost his painkillers when he accidentally dropped his fishing tackle box overboard during a fishing trip. He claimed that along with hooks, sinkers, and lures, he lost his pills which he kept in the box during such trips.”

“Sometimes we give them the benefit of a doubt,” Dr. Ladak said. For example, after listening to the fellow talk so convincingly that he lost his pills in his tackle box, she said, she concluded that nobody would go to such lengths as to make up such a bizarre story, so she prescribed him painkillers. Much to her amazement, the same man returned to the ED at a later date saying that he’d again lost his painkillers. He used the very same excuse, most likely thinking that since the excuse worked once, it would work again. He was wrong.

One trend that Dr. Ladak said she has noticed is that when there is a large heroin bust in the region that puts dealers out of business, there is an increased number of people who visit the ED seeking painkillers to alleviate “pain”. Doctors have to determine whether the people are in pain, or if they’re trying to substitute the lack of heroin with prescription painkillers.

“When some of them come in they’re driven,” Dr. Ladak said of the people they suspect of being addicts. When these individuals are offered non-narcotic substitutes, they won’t hear anything of the sort. They are insistent that the only way to alleviate their pain is through the use of narcotics. When they don’t get what they’re looking for, Dr. Ladak said, some of them direct an immense amount of anger at the attending physician.

Signs of legal and illegal use of painkillers

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

“The drugs make you feel better, but they may make a painful emotional situation better rather than one that is causing physical pain,” Dr. Ladak said. She and other area doctors often refer addicts, and people trying to overcome their addiction, whether it is to prescription painkillers, or illegal narcotics, to Tri-County Substance Abuse Services. The organization’s phone number is (802) 334-5246.

Persons that feel they may have developed a problem should discuss it with their physician or contact Tri-County.