Prescription for Abuse (2012)

Prescription for Abuse
  • KCTS 9 Documentary

Prescription for Abuse

A report on the alarming increase in prescription-drug abuse in Washington state.

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Prescription for Abuse: Washington Tries to get Serious

Responding to concerns about excessive prescribing of drugs, Washington state has new rules in effect. But will it make a difference in a trend that is claiming more lives nationally, including among the young.

JAN. 22, 2012
By Carol Smith
InvestigateWest

Dr. Rosemary Orr didn’t see it coming that day. It was the morning after Mother’s Day. She needed a ride to work, so her 24-year-old son Robin drove her. She was in a hurry to get to Children’s Hospital and Medical Center in Seattle, where she is a pediatric anesthesiologist. Otherwise, she says, she would have spent more time talking with him.

She’d been worried about his sleeping habits, his weight loss lately. She knew her smart, handsome son had struggled with addiction to OxyContin in the past. But he’d kicked it. He’d assured her of that. He’d looked her in the eye and said, ‘You don’t have to worry about me, Mom.”

No parent wants to believe her child is using. Not even one who is a doctor.

“I was stupid and desperate enough to believe that explanation,” Orr says now, five years later, over coffee a few miles from her work, where she takes care of the pain of others. Her own pain, she takes with her.

When she got home from work that day, Robin’s phone was ringing, but he wasn’t answering in his room downstairs. She knocked. And knocked again. She went around her house and peered in through his bedroom window.

Her son was on the floor, dead of an overdose.

Orr’s son is one of thousands of Americans, including a growing number of young people, who have died from prescription pain medications, powerful opiates that one emergency room doctor described as “just a fancy form of heroin.”

With a law that took effect this month, Washington state is making a bold attempt to reduce overdose deaths by launching the first-ever dosing limits for doctors and others who prescribe these medicines. The law has been heralded as one of the toughest in the nation, but loopholes and pitfalls in the system remain.

Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country, despite lawmakers’ attempts to get a grip on it. Washington now has one of the highest death rates in the nation. Deaths from prescription drug overdoses in this state have skyrocketed nearly twenty-fold since the mid-1990s, and now outstrip those from traffic accidents.

In King County, deaths from prescription opiates exceed deaths from heroin, meth, and cocaine combined.

Washington has been one of the hardest hit states in the country, in part because of aggressive prescribing practices. That, coupled with lack of oversight of doctors who over-prescribe, has led to the spectacular run-up in the number of deaths from prescription overdoses.

Dr. Russell Carlisle, head of Swedish Medical Center’s Cherry Hill Emergency Department in Seattle, was shocked by the volume of painkillers doctors were prescribing in Washington when he first moved here from California in the mid-1990s.

Running between exam rooms during a recent busy afternoon in his ER, Carlisle recalled that California maintained tight control of pain medication, requiring triplicate documentation for opiate prescriptions at the time. But in Washington, emergency room doctors were routinely handing out prescriptions for 30 to 40 pills at a time, even to people with histories of drug habits.

Why? “Because then they wouldn’t come back,” he said.

But that efficiency turned deadly. “The higher deaths, and probably abuse, too, I believe has to do with higher supply or availability,” said Jennifer Sabel, an epidemiologist with the state Department of Health.

An InvestigateWest analysis of U.S. Drug Enforcement Administration data shows Washington ranked fourth highest nationally in per-capita prescribing of methadone in 2006 (the most recent year for which reliable data is available) and 11th for oxycodone — the two biggest killers.

Even more disturbing, more than half of all prescription drug-related deaths in the state occur in the state’s poorest and most vulnerable population — people on Medicaid, a population that is itself exploding in our recent economy. A 2009 federal study showed the age-adjusted risk of death from prescription opiates in Washington was nearly six times higher for Medicaid enrollees than those not on the program.

“Medicaid has about a death a day from prescription narcotics, and in the last two years, it’s continued to escalate,” said Dr. Jeff Thompson, medical director for Washington’s Medicaid program. Many of those deaths are among young people, he said, a trend that also has public health experts concerned.

New addicts are getting hooked at younger and younger ages, said Caleb Banta-Green, a research scientist at the University of Washington’s Alcohol and Drug Abuse Institute.

“The largest group of people entering treatment for prescription abuse right now is made of young people between the ages of 18 and 24.”

The making of an epidemic

Washington’s emergence as a state with one of the highest rates of both opiate prescriptions and deaths was not, in hindsight, an accident.

In 1995, Purdue Pharma introduced OxyContin along with an aggressive marketing campaign pitching the drug as a salvation for chronic pain. The next year, Washington’s medical profession did an about-face in its approach to pain management. The state’s Medical Quality Assurance Commission issued new liberalized guidelines addressing the under-treatment of chronic pain. By 1999, they had been codified into law.

The 1999 law specified, “No disciplinary action will be taken against a practitioner based solely on the quantity and/or frequency of opiates prescribed.”

The relaxation of the rules resulted in a run-up in prescriptions. “Since the law changed, the average daily doses in morphine equivalents have gone through the roof,” said Dr. Gary Franklin, medical director for the state’s Department of Labor & Industries. In 1998, the average daily dose was 80 mg. By 2002, it had nearly doubled to 140 mg.

The same trend was going on around the country. In 1997, prescription opiate sales amounted to 96 mg per person in the United States. By 10 years later, they had mushroomed to 698 mg per person, Franklin said. “That’s enough for every American to take 5 mg of Vicodin every four hours for three weeks.” In 2010, the levels increased still further, enough to medicate every adult around the clock for a month.

Franklin was among the first to notice an alarming corollary effect: the drugs used to kill pain were also killing people.

“Workers were coming in for low back sprains, and dying,” he said. Franklin and his colleagues published the first paper in the country to link worker deaths to prescription drugs in 2005. But when he presented his findings at medical meetings, he faced backlash from the profession and the drug industry.

Many in the profession had fought long and hard to get access to these drugs for better pain management of chronic pain patients, Franklin said. “They didn’t want to hear it might be killing them.”

In May, 2007, Purdue Pharma sent Franklin a three-page letter blaming deaths on patient abuse and disputing Franklin’s contention the drugs were being overprescribed. A day after he received the letter, Purdue executives pleaded guilty to misleading the public about the addiction potential of OxyContin, and agreed to pay a $600 million fine.

"Preferred drug"

As the deaths and hospitalizations continued to mount, an even more unsettling trend emerged — the disproportionate escalation of deaths among the state’s Medicaid population.

Looking back, the rise in the death rates of Medicaid patients tracks along with the state’s cost-saving decision to move many of its poorest residents to the cheapest, most potent pain reliever available: Methadone.

In 2003, the state agency that administers Medicaid made methadone the “preferred drug” for long-acting opiates on its formulary, the list of drugs Medicaid covers. Because methadone is so much cheaper than oxycodone or other types of pain pills, the move drove down costs considerably, said Thompson. A few years ago, the agency was spending $20 million annually on pain meds for Medicaid patients. Now it spends about $12 million, he said.

But as costs came down, deaths went up. And many patients are still on high doses of painkillers. Medicaid has between 3,000 and 4,000 patients in Washington who are already over the new legal threshold of 120 mg a day, he said. About 700 of them are over 1,000 mg a day, and a few people are on up to 10,000 mg a day.

Studies have shown the risk of death increases up to nine-fold at 100 mg a day.

“You have to be careful with methadone because it accumulates in the body,” Thompson said.

A fix in the works

A few years ago, Rep. James Moeller of Vancouver, who is a drug-abuse counselor by trade, noticed a strange thing happening in his practice. More people were coming to him addicted to legal drugs than illegal ones.

“People would be sitting in my office, wondering how they got there,” he said. “Often it had started with a minor injury.”

Franklin of the state’s Department of Labor & Industries, and University of Washington pain expert Dr. Alex Cahana were seeing the same trends. Even more unsettling, they were seeing more people dying from addiction to these drugs. Together, the three began a battle to set rules around prescribing pain meds. Their efforts culminated in the passage in 2010 of RCW 2876, which repealed the old rules and put into effect strict new rules for pain medications. The rules, which don’t apply to patients suffering acute pain from injury or surgery, or to those with cancer pain or in end-of-life care, went into effect Jan.2.

The new rules specify that when a patient exceeds a dosing threshold of 120 mg per day of morphine-equivalents (a standard measure of narcotic strength), the patient must be evaluated by a certified pain management specialist. The law also contains requirements for pain evaluation, and continuing education for providers.

Dr. David Tauben, a clinical associate professor and director of medical education in pain management at the University of Washington, said the new law will give doctors better tools to treat pain, which is among the most difficult conditions physicians see.

Historically, doctors haven’t understood the limitations of using opiates to treat pain, he said. “They thought, if some is good, more is better, and when more stops working, give even more.” That thinking followed a shift in the medical culture during the late 1990s toward more aggressive treatment of chronic pain. And it’s one reason there are so many people on high doses of pain meds right now.

The trouble is, the pain medications themselves can worsen the problem, contributing to heightened sensitivity to pain, a condition called “opioid-induced hyperalgesia.” As a result, many people find it difficult to taper off the medications. Others unwittingly get addicted after taking narcotic medication for long periods of time.

The law will help better educate doctors about what does work for pain management, Tauben said. “We’re trying to fix the mess the pain community inadvertently created.”

Not everyone is happy with the tightened statute, however. The pharmaceutical industry has opposed the law. Some drug companies have mounted campaigns fronted by patient advocacy groups or policy centers.

The University of Wisconsin’s Pain & Policies Group, one of the most influential policy advisors in the nation, for example, was recently revealed to have failed to disclose its funding relationships with drug-makers.

In Washington, the American Pain Foundation, which bills itself as an independent nonprofit, but receives the bulk of its funding from Endo, the makers of generic OxyContin, has mounted a sophisticated media campaign critical of the pain-management laws and claiming pain patients are suffering unnecessarily.

Some in the medical community also say it unfairly penalizes legitimate pain patients, and doctors who prescribe for them.

Dr. James Rotchford of Port Townsend has been critical of the new law. Rotchford, who lost both his Drug Enforcement Administration registration and his Medicaid contract after the DEA raided his Port Townsend offices in 2010, said the real problem is inadequate pain management and addiction treatment for those who are already on the drugs.

“The law is on the other end of it,” he said. “The problem starts before they get to 120 mg (a day.) We’re not doing anything to prevent the problem.”

"The biggest pushers"

There’s plenty of blame to go around for what caused the epidemic — aggressive marketing of opiates by drug companies, nonexistent tracking of overprescribing, lack of insurance coverage for alternative treatments for pain, and demand by patients for quick fixes, to name a few.

Ending the epidemic will require attention to all these issues, but also a fundamental change in the way the medical culture deals with pain.

The pain that Rosemary Orr felt when found her son dead of an overdose sparked an effort to protect patients: She helped start P.R.O.P., Physicians for Responsible Opioid Prescribing, which is dedicated to promoting cautious, safe and responsible prescribing practices.

Orr is haunted by a quote from her son: “Mom, you have to see — doctors are the biggest drug pushers in the country.”

She wants to change that.

“Teenagers are given oversupplies of Vicodin for things like wisdom teeth extractions. Surgical patients get more pills than they need when they leave the hospital. People take them all because they figure, 'Gee, if a doctor prescribed it, it must be safe,' " she said. “Before they know it, they’re addicted.”

She points out, too, that this is an American problem.

“The U.S. is responsible for about 90 percent of the world’s prescribing of Vicodin,” she said.

In Britain, where she grew up, she recalls breaking her leg in three places when she was 14 years old. ‘My father was a doctor,” she said. “He gave me an aspirin.”

Americans are notorious for their pill-popping. Addiction is minimized and glamorized by shows, such as House, featuring a doctor who pops Vicodin like Chiclets. There are consequences to that, said Orr, whose son is never far from her thoughts. She writes: “Sometimes, I feel his presence and sense that he is encouraging me to tell others what I now know so that perhaps one life will be saved.”

Part II: New Law Holds Promise, but Concerns Linger | INVW.org

A note about this project: This story is part of an ongoing collaboration between KCTS 9 and InvestigateWest, an independent nonprofit newsroom covering the Pacific Northwest. The KCTS 9 documentary airs at 9:00 p.m. Jan. 30.

About the Film

About the Film

KCTS 9 and InvestigateWest report on the alarming increase in prescription-drug abuse in Washington state, looking at doctors who overprescribe, the lack of regulation or treatment options, and how this epidemic is affecting teenagers, seniors and middle-class families.




About the Filmmaker

About Ethan Morris

Ethan Morris is the Executive Producer of Public Affairs at KCTS where he oversees local broadcasts including weekly programs, specials, town halls and investigations. Before coming to KCTS, he was the Senior News Producer at KOMO-TV in Seattle and a special commentator for ABC’s World News Now on Northwest news stories and issues. He has won three Emmy Awards, three regional Edward R. Murrow Awards, and the National Edward R. Murrow for coverage of the 2001 Nisqually Earthquake.

About the Reporter

About Carol Smith

Carol Smith is editor and co-founder of InvestigateWest, a regional nonprofit journalism studio focused on the environment, public health and government integrity. A long-time print reporter, she was nominated for a 2010 Emmy award for her work on healthcare workers who handle chemotherapy. She won the 2009 Casey Medal for Meritorious Journalism for her work on mental illness, and was a 2006 finalist for the PEN Literary awards. In addition, her investigative work has been honored by the Blethen Awards, and she was co-finalist for Harvard University’s Goldsmith Prize in Investigative Journalism.

Featured in the Film

  • Dr. Rosemary Orr
  • Caleb Banta Green
  • Gina Grappone
  • Dr. Russell Carlisle
  • Gil Kerlikowske
Dr. Rosemary Orr
Dr. Rosemary Orr

Dr. Rosemary Orr lost her son, Robin, to an overdose of OxyContin and cocaine in 2005. After his death, she helped create P.R.O.P., Physicians for Responsible Opioid Prescribing, which is dedicated to promoting cautious, safe and responsible opioid prescribing practices

Caleb Banta Green
Caleb Banta Green

Caleb Banta Green is an epidemiologist with the University of Washington’s Alcohol and Drug Abuse Institute. His research has tracked a surge in prescription drug abuse and overdoses in Washington during the last 10 years, and a corresponding increase in heroin use.

Gina Grappone
Gina Grappone

Gina Grappone is the Executive Director of SAMA, the Science and Management of Addictions, dedicated to eradicating substance abuse of all kinds among youth. SAMA offers treatment and support for young people and their families dealing with the disease of addiction.

Dr. Russell Carlisle
Dr. Russell Carlisle

Dr. Russell Carlisle is the Medical Director of the Emergency Department for Swedish Medical Center’s Cherry Hill campus, where he implemented the “Oxy-Free ED” program, which tries to reduce the amount of opioids prescribed by emergency room physicians. The program has spread to six other Swedish campuses, and 50 hospitals across the country.

Gil Kerlikowske
Gil Kerlikowske

Gil Kerlikowske is the Director of the White House Office of National Drug Control Policy, who calls prescription drug abuse the fastest growing drug problem in the nation and an epidemic.

Testimonials

  • Sean Riley
  • Rayne Pearson
  • Deborah Long
  • Matt Brooks
  • Rose Dennis
  • Maria Downing
Sean Riley


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Sean Riley is a former police officer who became addicted to prescription drugs. He lost his job after he was arrested on drug charges. Following drug rehabilitation therapy, Sean founded Safe Call Now, a crisis line for public safety workers like police, firefighters and corrections officers struggling with substance abuse. The Washington-based program is now helping public safety workers nationwide.

Rayne Pearson


Can't watch the above video? Watch it on YouTube

Rayne Pearson became addicted to prescription opioids after her doctor prescribed Vicodin for her following the birth of her first child. Now in recovery, and a successful practicing attorney, Rayne tells how stereotypes of the “back-alley drug addict” are just plain wrong, and harmful to those who need help.

Deborah Long


Can't watch the above video? Watch it on YouTube

Deborah Long started using prescription opioids after an on-the-job injury, and ended up drug seeking at local emergency rooms. Deborah says getting drugs from ERs and doctors was all too easy. She is now in recovery and a student at Olympic College earning a degree in Human Services.

Matt Brooks


Can't watch the above video? Watch it on YouTube

Matt Brooks describes how his addiction to prescription opioids turned into a heroin addiction after drugs like OxyContin became too expensive. Matt says too many people don’t understand that prescription opioids and heroin have the exact same effect on the brain. Matt is now in recovery and is a student and musician.

Rose Dennis


Can't watch the above video? Watch it on YouTube

Rose Dennis shares how her son became addicted to opioids at the age of 13 after he was diagnosed with leukemia and required and opiate drip for treatment. She is now on the Board of SAMA, the Science and Management of Addictions, and wants doctors to understand the powerful nature of prescription opioids on adolescents.

Maria Downing


Can't watch the above video? Watch it on YouTube

Maria Downing lost her son to an overdose after his life-long struggle with opioids and other drugs. Maria says her son always thought he had control of his addiction, but was never able to stop using. She is now on the Family Action Council of SAMA, working to educate youth about addiction.

Resources

University of Washington Alcohol and Drug Abuse Institute
Established in 1973, ADAI conducts vital and comprehensive substance use abuse research which is made available to health and social service professionals, policy makers, and the public. The Institute’s mission is to improve the understanding of, and reduce the harm caused by alcohol and drug abuse. This interactive map includes data on a county-by-county basis and important links to treatment services.
Link: http://adai.uw.edu/

Science and Management of Addictions (SAMA)
Dedicated to eliminating the disease of substance addiction in youth, SAMA helps young people and families by providing drug and alcohol assessments, treatment planning, referrals, outpatient treatment services, parent groups, and other resources. Call to schedule an assessment or parent intake session.
Phone: 206-328-1719
Link: http://samafoundation.org/

Safe Call Now
A crisis referral line for police, firefighters, corrections officers and other public safety workers and their families who are dealing with substance use issues. Phone lines are staffed 24-hours by professionals who understand the unique demands of public safety work. All calls are confidential.
Phone: 206-459-3020
Link: http://safecallnow.org/

Addictions Treatment Center, VA Puget Sound Health Care System
The Addictions Treatment Center provides treatment for veterans experiencing difficulties with drug or alcohol use. The program treats substance use in conjunction with other issues such as PTSD and depressive disorders. Call to schedule an evaluation.
Phone: 206-764-2081
Link: http://www.pugetsound.va.gov/

Physicians for Responsible Opioid Prescribing (PROP)
PROP provides information and educational materials for doctors, health care providers, and the public. The organization’s mission is to reduce deaths resulting from the prescribing of opioids, and to promote cautious, safe and responsible prescribing practices.
Link: http://responsibleopioidprescribing.org/

UW Medicine Division of Pain Medicine
Provides inpatient and outpatient services at five area hospitals for diagnosing pain from injury, surgery and disease, and preventing pain from becoming a disabling disease. Doctors pursue precision diagnosis, target specific treatments, and address prevention, patient education, and lifestyle changes in conjunction with medical therapies.
Link: http://depts.washington.edu/anesth/care/pain/index.shtml

UW Pain Medicine Provider Toolkit
A valuable educational resource for doctors and providers about safe opioid prescribing practices. Includes an Opioid Dose Calculator, pain management guidelines, and information about the Prescription Monitoring Program and the ED Information Exchange.
Link: http://depts.washington.edu/anesth/education/pain/index.shtml

Prescription Monitoring Program
Information for pharmacists, dispensaries and physicians about the new Prescription Monitoring Program, including how to register and compliance requirements.
Link: http://www.doh.wa.gov/hsqa/PMP/
Link: PMP Fact Sheet http://www.doh.wa.gov/hsqa/PMP/documents/publicfactsheet.pdf (PDF file)

Opioid Prescribing Guidelines (WA ED Opioid Abuse Work Group)
Recommendations for doctors, emergency departments, and other providers on the prescribing of opioids for non-cancer pain. Guidelines developed by the Washington Emergency Department Opioid Abuse Work Group sponsored by the state Department of Health.
Link: http://depts.washington.edu/fammed/files/CE_WA%20ED%20Opioid%20Abuse%20Work%20Group_51.pdf (PDF file)

CME: Opioid Dosing Guidelines
A Continuing Medical Education tool for physicians, pharmacists and others in the health care community who prescribe opioids or are involved in the management of chronic non-cancer pain.
Link: http://www.agencymeddirectors.wa.gov/activity/start.asp

WA Dept. Labor & Industries Medical Treatment Guidelines
Guidelines from L&I for the outpatient prescription of oral opioids for injured workers with non-cancer pain.
Link: http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/Opioids.pdf (PDF file)

CDC Vital Signs: Prescription Painkiller Overdoses, November 2011
Link: http://www.cdc.gov/vitalsigns/PainkillerOverdoses/index.html

Office of National Drug Control Policy
The 2011 Prescription Drug Abuse Prevention Plan which includes strategies for education, monitoring, proper medication disposal and enforcement.
Link: http://www.whitehouse.gov/ondcp/prescription-drug-abuse

Comments

03/23/12

This is not always true. I have done two years of physical therapy, followed by two years of massage therapy and acupuncture. I have seem more than one for each and i would keep having to go back for the rest of my life for some relief. It depends on what is wrong. I do understand how everything is connected. I learned that a long time ago when i first got hurt. I have a good understanding of the body, i can meditate, and have seen many things before they happen. After i told my doctor this years ago we started on other treatments that were not so big pharma only. I still need my meds but other things do offer some short term relief, or it helps things get even more manageable.

01/30/12

And massage therapy!
Human touch- for both pain and addiction is incredibly therapeutic.
I have had many clients comment that they need little or no medication after they have had a massage.

01/30/12

How Bout this for thinking outside the box. Lets pay the poppy farmers in Afghanistan to supply heroin for soldiers who destroyed their homes. Screw the pharmaceutical conglomerates. Lets use opium in its purest form -heroin. lets use it responsibly, prescribed by a physician. Lets monitor it. Use it responsibly. Better yet, smoke marijuana. We'll all be better off. cheers

02/02/12

How about not? You said use it responsibly twice, goes to show that stuff messes with your brain. And you obviously use, if not heroin then pot for sure.. Keep those comments to yourself. :) cheers

01/30/12

Where is the pharmacist on this panel (recommendation panel)????? Doctors are trained in diagnosis and treatment,, not medication propagna from drug companies! Doctors are part of the problem and should rely on the profession that supports their work for the patient.
My mother was a pharmacist for over 50 years in Canada and she was instrumental in a database to track narcotic prescriptions and going after doctors that are over prescribing these medications. I myself have always sought alternative treatment to drugs...pain management programs WORK...I use it daily!
Please consider consultation from drug scientist (pharmacist
Thank you!)

01/30/12

I wish there were a chronic pain advocate on your panel tonight.

01/30/12

The jump in prescribing opioids stemmed from our OWN health organizations advising doctors to prescribe pain medication, yet now the government is punishing the doctors whom did just that. Logically we will inevitably end up back where were, with a vastly untreated "public health" issue that is life threatening, causing great distress on Washington's citizens, families, economy, and more. There must be a solution that both allows honest and adherent chronic pain sufferers to access care but also lessen abuse, otherwise the medical community is failing to uphold its central purpose: provide care.

PBS, please offer more information on what has been said in these comments about a balanced approach to this issue, as you also have a responsibility to the public, and now, to the chronic pain community to show their side of this experience too. How do these regulations affect them, their doctors, their health? How far do they travel to see doctors or specialists? Have pharmacies rejected their prescriptions? What extra costs do they incur just to prove they are legitimate patients over and over(which I doubt is forced on Diabetics or Cancer Patients)? Are they treated as if they have committed crimes when they have not? Ask them about the prejudices they face, just like the judgement we see shown on this program. Ask them how they feel about your program.

03/23/12

I will tell you. I am looked at like a criminal. I drive an hour to my doctor. There is not a pharmacy within 100 miles that has my meds, or lies to me about not having them. If they do have them they want $600-$1000 for something i should pay no more than $150 for. I have a prescription right now that i have not been able to fill in two weeks. I have spent abt $200 in gas driving from pharmacy to pharmacy because nobody can tell you if they have it over the phone, then i come home and die because the car hurts after an hour. The DEA has put limits on how much of what a pharmacy can sell, so after the 10th of the month good luck. Oh and we have a database, i thought it would help, i guess not. If you are not in chronic pain, you don't get it. I have some family members who think i am scum, or lazy, because of what is going on thanks to programs like this one. Maybe i can sue them for slander and making my quality of life worse. OH wait that will never happen. The opposing lawyer would say "hey he is lazy and trying to get a quick buck." It's funny how the article from seattle the gov't covers switching people to Nazi made methadone which kills more people and is way cheaper for workmans comp. It all comes down to money. Heck i am sure Allstate was calling me yesterday for this reason. They had questions. I am sure ti will be about my medicine i need after their customer hit my car.

01/30/12

Here, here!
I work with people with pain everyday. Some people have situational pain which usually resolves in fairly short periods of time and others have chronic pain, often daily, with "good" and "bad" days. I hear stories of the difficulties they face when trying to get appropriate treatment for their conditions.
I second the concerns of S. Wilcox and although I feel the measures stated on your program are valid and worthy I can see how they could also impact the people who rely on their pain management to have as functional a life as they possibly can.
While there are many contributing factors to this whole issue and alot of "fall-out" around it, I feel the very core of this issue is ADDICTION and how to help the addict and the underlying causes of addiction.
PLEASE make sure of the distinctions between "valid" perscription users and people with the unfortunate disease of drug addiction and PLEASE apply the guidelines and assistance accordingly.

01/28/12

I salute those who have called for a balanced report on the issues of medications that have been prescribed FOR THE RELIEF OF REAL, DOCUMENTED, CHRONIC PAIN. They have not been prescribed for the purpose of recreation, which is implied by both the title and content of this unfortunately sensationalized program.

Doctors who treat chronic pain are now being hounded, not only by the new, otherwise well-intended regulations regarding use of opiates for chronic pain, but by unbalanced programs such as this one that look at only one side of this complex issue.

I sympathize greatly with those who have lost family members or loved ones to the misuse of drugs originally prescribed for the legitimate purpose of relieving pain. The RECREATIONAL DRUG USER doesn't get very far within the legitimate medical community to get his or her drugs. We doctors are constantly on guard and watchful for recreational drug users--they may fool us once but they won't do so for very long. We count pills, refuse early refills or refills for "lost" or "stolen" drugs, we have painfully detailed Pain Contracts, we do urinalyses to not only make sure the patient is not taking other drugs, but to make sure they're taking what is prescribed (as opposed to selling their prescribed medications.)

It is because of sensationalized programs such as this that those of us who are willing to treat chronic pain are marginalized and suspected, or even accused, of careless or unethical behavior or practices. Ask any chronic pain sufferer how nearly impossible it is now to find a doctor who will treat chronic pain with opiates; I am getting referrals daily from other doctors who will no longer treat ANY chronic pain patients, even ones they have known and treated for year. This is a terrible disservice to the many suffering individuals who need our professional expertise and help. Instead, we are now denying them the needed medications that will allow them to function in everyday living.

There are two sides to every story. It's too bad that KCTS 9 has chosen to show only one side of this very complex issue.

01/27/12

There is a glaring lack of balance in reporting on prescription pain medications, and sadly PBS is guilty of this as well. The media has a responsibly to report all sides of a social issue to the public, and this biased reporting has only showcased the negative consequences from the MISUSE of these medications. These medications make lifesaving surgeries possible and make life livable for millions who would otherwise probably choose death without them.

And all the while, many patients are turned away because Washington's doctors/clinics are frightened by this condemnation of treating pain, and many other patients do not seek treatment at all because of this type of fear mongering. Fear mongering which is unnecessary when doctors, pharmacists, and therapists are able to do their jobs. And it is a doctor's decision to choose whether or not the risks outweigh the benefits to the patient. Period.

People's lives are at stake: not just the lives of those who abuse, but the lives worth living of those who take these treatments 100% legally and appropriately. They should not be punished; they should not suffer further.

I await a report on the positive effect these medications have. I look forward to seeing more on PBS about the chronic pain community, our very few Pain Management Specialists here in Washington, and the people who suffer every day with debilitating pain and the prejudice against our disorders and treatments.

01/27/12

In response to:

“Please also investigate your sources, such as PROP. The president has a history with Reckitt Benckiser, maker of suboxone”…

PROP (Physicians for Responsible Opioid Prescribing) does not have any relationships with any pharmaceutical companies.

It is true that I have worked on expanding access to opioid addiction treatment, especially buprenorphine (suboxone) but I do not have a relationship with Reckitt.

I’m not offended by the question. On the contrary, whenever one hears a doctor, professional organization, or a “patient advocacy” group (i.e. the American Pain Foundation) speaks out in favor of a drug or class of drugs, this is exactly the question that should be asked.

Had the public and the medical community been asking these questions 15 years ago, it’s very possible that the epidemic of opioid overdose deaths and addiction might have been avoided.

I would suggest two resources that can be used to identify financial relationships between drug makers and doctors. Keep in mind that each of these databases has its limits… so it’s possible for a doctor to have significant financial relationships that don’t appear.

http://www.pharmafiles.net/index.php?view=group

http://projects.propublica.org/docdollars/

Try plugging in the names of the doctors who argue that opioids are not addictive and the doctors that have attacked Washington State or the CDC for their efforts to address over-prescribing of opioids. You are likely to find that they receive payments from companies that make opioids.

And here’s an excellent recent article from the Washington Post/ProPublica about the American Pain Foundation, the group that’s been leading the fight against the Washington State effort:

http://www.propublica.org/article/the-champion-of-painkillers/single

02/05/12

I do beg your pardon, Mr. Kolodny! I am one of those doctors who has tried to address the unintended consequences of the new regulations regarding prescription of opioids for chronic pain: consequences such as primary care physicians (now 80% of them) refusing to provide care for ANY chronic pain patients, regardless of the situation, and including patients they have personally prescribed and cared for for years. Many patients are now unable to find a doctor or other provider who is willing to take them on for chronic pain management that involves opiates.

To suggest that people like me are likely to be receiving payments from a company that makes opiates is a very broad and foul-smelling net indeed. You owe an apology to all those ethical and legitimate doctors and other providers whom you have impugned.

02/18/12

I do not believe that every doc who's concerned about potential unintended consequences of the WA legislation is on pharma's payroll. My apologies for making it sound that way.

02/01/12

For a more balanced article and one that debunks this Pro Publica piece, check out http://www.stats.org/stories/2012/attack_painkillers_misusing_statistics...

01/27/12

The emotional response to this documentary is palpable. Narcotics are addictive. Over time the need to increase the dose to acquire the desired result occurs and that may lead to an overdose when the dose reaches toxic levels. The ER's of this country are filled daily with drug seekers who will do anything to get their hands on their drug of choice. Dr Offices are filled with drug seekers who also will do anything to get their drug of choice. For example a patient will go to multiple MD's using their married name at one office and their maiden name at another office while having their prescriptions filled at multiple pharmicies to avoid detection. This practice is common and illegal.
Those who need the narcotics should get them and be monitored by their prescribibg MD. Those who abuse the narcotics should safely be withdrawn from the narcotics and monitored. Washington state will be implimenting a computer based narcotic data base so that when a patient is prescribed a narcotic the MD and dispensing pharmacist can monitor useage and frequency of prescriptions. This database will be available to all Liscenced practioners and hopefully decrease the over prescribing and abuse of narcotics.
It is unfortunate that such actions must be taken. However the problem of prescription drug abuse has become too large to be ignored.Sould this program save the life of one person then clearly it is justified.

03/23/12

If i read correctly they already have done this, yet it was too expensive and just let it go.

01/26/12

In this article Dr Thompson states "“Medicaid has about a death a day from prescription narcotics, and in the last two years, it’s continued to escalate,” said Dr. Jeff Thompson, medical director for Washington’s Medicaid program. Many of those deaths are among young people, he said, a trend that also has public health experts concerned."

But in a recent Seattle Times Article Dr Thompson stated that the Deaths (from opioids - "narcotics") were decreasing. So Dr Thompson which is it...are the deaths decreasing or are they continuing to increase?

01/27/12

In answer to the question posed regarding Dr. Thompson's quote in the story, Dr. Thompson states: DOH has not been able to break down the death data to Medicaid and non-Medicaid in the most recent data. In last data set we did have a breakdown Medicaid had not seen a reduction.

01/26/12

Though I've commented above, upon rereading this article so full of misinformation I want to add to my previous statement. Dr. Orr implies that patients who take opioid medicines prescribed by their physicians that "...before they know it they are addicted." First of all, I'd love to see the evidence that proves this. Secondly, those of us whose lives have been saved by opioid medicines simply do not, before we know it, become addicted. We take these medicines under our physicians instructions and very, very few of us doctor or pharmacy shop, sell our medicines to others or take more of the medicine that is prescribed to us. Though there are some who do, that number is very small and should not be a reason to deprive me and millions like me the life changing relief that comes with the considered use of these medicines. And while it makes a good story and sounds ever so dramatic to quote Dr. Orr's son as saying "doctors are the biggest pushers out there," this statement is preposterously misleading and damaging. Again, I would like to see the research evidence that supports such ill considered hyperbole. Finally, the writer and editor of this article should have dug much deeper into this problem and not published half-truths and ridiculously unsupported statements. That is not responsible journalism. Remember, what you have written may have a deleterious on the 116 million of us who are simply trying our best to live with bodies subjecting us to horrendous pain.

01/26/12

Has anyone bothered to check out the link to the "CDC's Morbidity and Mortality Weekly"? Table 2 has Washington State OPR deaths listed under non-medical use- now that's interesting. I would venture to guess that most of the deaths cited are coming from this category- the "recreational drug use" sector, although the link of poverty to chronic pain is not a new one. When I was growing up, many of the blue-collar workers in my neighborhood had been repeatedly injured on the job, and many of them had become alcoholics, or both legal and illegal drug addicts, by necessity of having to continue to work with injuries so severe, they had no other choice but to become addicted to feed their families. I experienced this first hand when my ex-husband, after a severe auto accident, injured his back badly. In order to continue working, he began to drink daily, and to take the Vicodin that our doctor offered him, along with the alcohol- his injuries were not amenable to therapy or surgery, so what was he supposed to do? And I assure you, he was not alone in this lifestyle.
I myself, have been a medical drug addict for over ten years, after a lifetime of severe rheumatoid arthritis, fibromyalgia, osteoarthritis, and now multiple sclerosis. I have been to all the appropriate specialists, and had to undergo a grueling "Step Process" of trial drugs, to find the ones that relieve pain that is non-responsive to therapy, surgery, hypnosis, or any other modality. I have also been in cognitive behavioral therapy for nearly 15 years, and can tell you this pain is definitely not in my head. I eventually ended up on time release morphine, the only drug that has alleviated any of my pain, and I signed a contract with my doctor that I take very seriously. And the only reason I'm on morphine is because Medicaid has restricted the allowable pain medicines to morphine and methadone- and methadone doesn't work for me. It also has a horrendous reputation for overdose deaths, probably because doctors and patients do not realize how strong it is.
The treatment of chronic severe pain is not just about how many people are dying because they are too screwed up to stop using these drugs recreation-ally- it is a political, economic, and subversively moral issue- I'm not interested in some religious entity telling me I can't take my pain pills because some deity wouldn't like it. This problem needs to come completely into the open now, so that all aspects of it can be examined and dealt with in an intelligent, unbiased way.For further information regarding the politics of pain, I refer you to The American Pain Foundation's excellent web site.

01/25/12

I first broke my back in 1976 and they should have installed a zipper then. I have had 5 spinal surguries so far plus a complete knee replacement. I have many things wrong with this body now and I take Oxycodone to control the pain. I am thankful that I have medical coverage through the VA so that I don't have to go through all the hoops to get help. I watch the next door nieghbor and all the crap he has to put up with for his vicodan. These people that are selling their meds or the ones that are steeling meds should be locked away and make sure they never get near any more. The physican should be able to tell if the symptoms are real and be able to prescribe based on that decission.

01/25/12

In response to this article: Prescription for abuse" I became angry and defensive regarding the statement: Prescription drug abuse is at epidemic levels throughout the state, and elsewhere in the country...etc. Unfortunately statements like these are barriers to appropriate and effective pain care!! I have experienced pain that eventually became chronic since 1984. I have had 13 surgeries in my life and have struggled at times to maintain a balance in my life for everyday living. I have had more reactions to medications which are non-opiate for my health challenges that have caused me more harm at times. I have ended up in the hospital 2 times with severe reactions to non-opiates; one of which was sending me into respiratory arrest but those medications are not seen as "evil" or addicting..just an "adverse reaction." The NSAID's caused "gut problems" and I had an ulcer that almost perforated but than can be some of the "side effects." In my opinion the opiate that I am prescribed is just another tool for managing my health challenges and pain. I have tried many modalities: medical/traditional and alternative/complementary but unfortunately some of those are not recognized by insurance for reimbursement. I worked in the health care arena for 38+ years and as a Rehab therapist have seen and experienced many doctors, therapists, other health care professionals, family members and even the patient themselves' attitude towards taking "pain medicine" because they didn't want to become "addicted." I would tell my patients that we needed to stay ahead of the pain to be able to do therapy to recover from whatever health issue they had going on at the time. There is a definition difference between "addiction" and "dependence." A diabetic patient is "dependent" on their insulin, a person with high cholesterol is "dependent" on their medication to manage their cholesterol...and so it goes...but the fear for a pain patient to be prescribed an opiate is to be labeled a "drug seeker," "drug user," or "addicted." This new law has limited the ability of the pain patient to have proper care to lead healthy, productive lives. Health care providers in this state are now either scared or don't want/can't take the time to manage pain patients!! I worked in geriatrics for many years and the Centers for Medicare and Medicaid Services in 2009 revised their guide for long-term care surveyors. F309, Quality of Care, includes a new general investigative protocol and new pain management guidance effective March 1, 2009. Persistent or chronic pain is recognized in the elderly and other chronic health problems and if untreated can make it hard to sleep, walk and carry out daily activities. It can lead to disability and take the joy out of living; which can be said for most chronic pain patients. Under treated pain drives up the cost of healthcare; extends stays in hospitals, increases emergency room visits and leads to unplanned clinic visits but unfortunately in Washington state there are very few clinics to go to with the enactment of this new law/guideline. Under treated pain also leads to lost wages and productivity of both people with pain and their caregivers. American employers lose billions of dollars a year on employee absenteeism as a result of pain. The recent Institute of Medicine report on pain recognizes there are 116 million U.S. citizens with pain which is more than diabetes, heart disease and cancer combined. And as a final thought recently there was a sign in my Veterinarian's office about managing pain in your pet. Our pets can receive better pain management than the chronic pain patient in WA state!!

01/25/12

I have been in constant harrowing pain for over 47 years. Until my late 30s I somehow managed to live with this monster. I had a private practice of psychotherapy and an adjunct professorship in psychology. I was married and the father of a small son when the world dropped out from under me. I was, after untold numbers of visits to physicians, finally diagnosed with Bechet's Disease which over the years spawned other painful conditions. After losing most of the vision in my left eye and living with untreated pain, I had to give up my profession, tennis, skating, basketball...I've undergone a dozen surgeries, physical and psychotherapy, massage, meditation, oh, you know the drill.It has only been in the last 5 years when I started taking an opioid medicine that I found that I was not spending great swaths of time wishing I was dead so as to be free of my body and its "little shop of horrors." I, like thousands and thousands of other people living with pain, take my medicine following my physicians advice, and while I've grown dependent on my medicine, I am by know means addicted. I take and store my medicine safely and comply with my treatment plan, just like millions of other people trying to live decently with pain.

I am sick of the production and dissemination of shoddy research that is latched onto by those in our society who want me not to have my medicine. I'm sick of the half-truths floating around out there about these classes of medicines. I don't crush my medicine and snort them. I don't take more than directed and wash it down with half a bottle of Jack. I've never given myself a hotshot of coke and Oxycontin.I don't give my opioids to family or friends, and I certainly don't sell them on the street.

While my heart goes out to families who've lost someone through the illicit use of a legitimate medicine, your loss shouldn't turn into my loss, or my family's loss. There are millions of us out here who, along with other treatments, use opioid medicines. It is intolerable that we and our courageous doctors are vilified. It's unconscionable. If it wasn't for opioid medicines, I truly believe I'd be dead by now. But I'm not, and I'm here to keep fighting for the human rights that are mine and the rights of millions like me.

01/25/12

As a person that has been living with chronic pain due to a back injury for years I am so happy we live in a world that everyone can voice their opinion. I have been on a multidisciplinary pain management therapy program for many years. By this I mean I use many different ways to combat my chronic pain and be able to have a quality of life that is somewhat normal. Just because a person has an opioid in their life to help manage the pain does not make them an addict. I only wish that I could somehow educate the people who think that if you take x amount of morphine, or Oxycontin, or Methadone, etc. you will become addicted. My chronic pain is something I have to live with for the rest of my life due to an accident. Untreated my pain levels are at a 9-10. This level of pain is so intense if not treated and controlled you will go into cardiac arrest and die. Everyone's pain level is different and to even think that there is a number that you can put on what is good for all is absurd. One person's pain may be controlled with 5 mg of some opioid where another may take 500 mg to achieve the same results. I am sad for so many people that have to put up with the ignorance of others. I would not want to go to bed at night thinking oh what a great person I am because I helped get a law past that I think is helping so many people. Wow aren't I a great person for doing this. Next time you lay your head down on that pillow I want you to stop and think about all the people that this has hurt more than you will ever know. Just the thought of knowing how many people that once had a somewhat tolerable life are having to go through a living hell because of this wonderful law. Now while were at it who gave anybody the right to criticize any non profit organization that does great work and helps so many people through education to help themselves. I don't care if they are getting funds through pharmaceutical companies or who it is what difference does that make when the bottom line is helping people. They don't tell people to use medication or anything at all for the pain they are having. All they do is try to answer questions that people and practitioners have concerning a case by case situation. I can only hope that someday we will not have to all watch our backside and god forbid that we become famous in someway. Famous people wake up with a reporter on the front steps just waiting for them to falter in someway. This is the way it seems to me and don't forget my opinion is just as important as yours so if you don't agree that is your right. The last I knew we live in America that was founded on the rights of all the people. I have much more I would love to say but I will just leave it at this. Until you have walked in my shoes and had to put up with the pain I have to live with 24/7s at least try to understand that pain is not something that is the same for anyone. We are all different and we all deserve the best care that is available.
Dan ONeal

01/25/12

I'm a clinic director of a large agency that specializes in treating opiate dependence. There are many possible approaches to helping folks suffering from prescription drug addiction.

KCTS is to be praised for bringing this complex and often hidden problem into the light.

People can reach out if they need help to our National Resource Center @ 866 762 3766

05/25/12

Pain Patient looking for doctors articles..this is really good. http://www.independent.org/pdf/tir/tir_10_4_02_libby.pdf

Are we really living in a Free United States? Why is the powers that be given so much power and by who?

Pain patients and doctors need to ban together.

06/27/13

Hey just wanted to give you a quick heads up. The text in your article seem to be running off the screen in Safari.
I'm not sure if this is a formatting issue or something to do with web browser compatibility but I thought I'd post to let
you know. The layout look great though! Hope you get the issue resolved
soon. Many thanks

01/25/12

Bravo to the persons in pain who responded to this article and lent a bit of balance to the picture of pain medication abuse and addiction. There are always 2 sides to every story. Balance is needed and the story needs to be seen from all sides otherwise an intelligent and effective solution will not be found. To think that just limiting the amount of pain medication that is prescribed will turn the tide of abuse and addiction is ludicrous. That is very simplistic thinking. More is needed to curb this problem...provider education, public consumer education, education in our public and private schools, education for medical students (they most often get less than 8 hours of pain education...which is why the majority of our health care providers today have no clue how to treat a person with pain whether it be acute or chronic or even end of life.) this is truly the foundation for this problem...NO EDUCATION. The health care Providers in this state are using this argument to their benefit. more than 70% of Community healthcare Clinics have made new policies to NOT treat persons with pain...thus in effect they are saying we are incompetent to treat pain therefore we legally should not be treating it. So where does it leave the person with legitimate pain? They are left to fend for themselves and suffer in silence, and return to a life with no quality or productivity and some are even contemplating suicide as a way to end their pain.
BUT there is a better answer...Education and exploration of how to get Alternative treatments more widely covered by insurance companies. Prescription pain medications are just one tool in the tool box of pain treatments. we need a shift in the paradigm of pain treatment. it is not an either or situation. It is what is the best thing for this individual patient. pain is very unique to each individual and requires a unique combination of treatment options. Healthcare providers need to be open to getting educated so that they can serve their population of persons with pain more effectively.
I speak from experience as a nurse with over 25 years of education and experience as a pain nurse consultant and over 30 years living with chronic pain. I teach complimentary pain management techniques to my clients. I also teach how to use pain medications safely and effectively.

01/24/12

Stories like the one you tell is sad indeed. Compared to the thousands of overdoses due to prescription opioids there over 116 MILLION Americans with chronic, disabling pain (Institute of Medicine, 2011). Pain that costs the US billions in lost productivity including work days and health care costs. This story sensationalizes drug overdoses at the expense of sufferers of pain and their caregivers. Most of the diversion of opiates occurs prior to the legitimate prescription being filled. There is no evidence that laws like Washington's will prevent diversion. Washington state and others who believe in this law are trying to fix the drug problem with a bandaid. It will not stop diversion and the individuals who suffer will be those with chronic pain and their caregivers. Filmmakers who only present one side of the story are irresponsible.

01/24/12

All I can say is, That the maker of Suboxone is really pushing for doctors to get everyone on that drug for his benefit. This is nuts. The popluation is larger than it's ever been, so statistics compared to years ago should not even be considered. When are these media reporters going to realize this? It's been since 1998? My God that was forever ago. I do not believe in hyperalgesia. I do believe in tolerance. If taken for many years more medicine is needed, but usually evens out at some point and can be maintained for many years. Medication helps my pain more than anything else. If I couldn't get relief then I don't want to live anymore. I'm sick of media's stupid statistics reports. They make me sick and never correct. The world has more than 7 billion people. Treat pain or people will die it's that simple and very sad.

01/23/12

It is important to remember that most people take their pain medications as prescribed. These medications help people whose pain is so severe that they would be rendered unproductive and unable to enjoy even the simple things in life. Education on using these drugs safely is key. We must not give in to the knee-jerk reaction of restricting access to opioids for the benefit of the irresponsible drug abusing minority, but to the detriment of the responsible majority. Any substance can cause problems when misused. If opioids fell off the face of the Earth, these troubled abusers would simply abuse other substances-- alcohol, heroin, even bath salts. Do we eliminate alcohol because some people are drunken fools? Do we eliminate cars because some irresponsible airheads drive distracted and cause accidents? Please do a feature on legitimate pain patients who got their lives back after being prescribed opioids. You can use the balance in your reporting. Please also investigate your sources, such as PROP. The president has a history with Reckitt Benckiser, maker of suboxone. What a financial windfall it would be, if everyone was yanked off their opioids and placed on suboxone! The corporate agenda here is obvious.

01/23/12

I am a patient suffering with chronic pain in my spine, neck, shoulders, hips, arms and legs. I have been diagnosed with several conditions of which there are no cures. Currently, I take an opioid medication to control my pain and utilize stretching, visualization therapy and supplements to help with the situation. I am also in a graduate program in biochemistry and molecular biology. Without my opioid medication, I would be either in bed or in a wheelchair and I most certainly would not be able to function in this graduate program. Opioid use, when precribed and managed safely and effectively, is an important aspect of care for those of us suffering from chronic, disabling pain. To assume that one medication (methadone) will work for all in pain is presumptive and dangerous. I have a list of opioid medication that is not tolerated by my body. If my medication is taken from me, I will no longer be able to work, will be forced to file for disability and will be forced to give up my dream of teaching high school science. I am not addicted, I take only the amount I am prescribed, have never had to fill a script "early" and have no problem with jumping through the hoops I must endure to get my medications (ie, urine testing and doctor/patient contracts). However, the more we restrict medications in order to prevent unwanted deaths of whatever group we are focusing on at the moment, the more difficult it will be for those of us who find the medication medically necessary to obtain what we need. We need to start enforcing the laws we already have on our book before we begin to write laws that restrict patients and prevent timely and effective care.

12/30/11

This is brilliant and I applaud the film makers for putting a glaring eye into prescription drug abuse. I want to share some information about opiate addiction: http://www.recoveryconnection.org/opiate-addiction-treatment-withdrawal/

Hopefully your show will get families to understand the effect of opiate abuse.

Namaste

Angela Weber

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