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Thread: Patients caught in middle of treatment vs. addiction debate

  1. #1
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    Patients caught in middle of treatment vs. addiction debate

    Patients caught in middle of treatment vs. addiction debate
    By Tom Kisken, kisken@insidevc.com
    June 1, 2003

    On bad days, the pain that began 20 years ago when Tim Wisenbaker broke two joints in his back makes him so sullen he won't talk to his wife.

    He seeks refuge in bed or on a reclining chair, sitting as if balanced on jagged rocks. The pain constricts his voice so words are squeezed from his larynx.

    The opiates he once swallowed at a rate of more than 250 tablets a day don't smother the pain but muffle it. Ask if he sees any alternatives and he pauses for a beat.

    "I could eat a gun."

    The prescriptions and dosages that made life bearable spun into jeopardy because of controversies as raw as Wisenbaker's back. His doctor, Michael Huff of Oxnard, is being investigated by Ventura County sheriff's deputies on the possibility that reckless, inflated prescriptions for OxyContin and other opiates fueled addictions and contributed to three deaths, according to an affidavit. No charges have been filed.

    Huff's medical license has been temporarily suspended. It could, in the most severe scenario, be revoked for at least three years by the Medical Board of California with the next step coming in a mid-July hearing. Huff declined to be interviewed for this story but previously asserted his innocence, saying he did his best to help patients whom other doctors leave in pain.

    The drama is stitched into a national dilemma on how to stop physicians who help turn patients into addicts without suppressing the right to have chronic pain treated as a medical crisis. The battle pits worries that painkillers with potencies similar to heroin are being sold on the street against concerns that otherwise responsible doctors are so scared of being investigated they won't prescribe narcotics offering the most powerful answers to pain.

    Though he defends Huff, Wisenbaker is convinced his connection to the doctor temporarily trumped his search for another physician who would prescribe similar dosages.

    "You can't get past the receptionist," he said sourly. "They say, 'Who was your last doctor?' You say 'Huff' and they say, 'Oh, we're not taking patients ...' You get the phone slammed down."

    It made his wife, Marion Thompson, worry about the not-so-good old days.

    Once a mechanic who worked on high-priced cars, Wisenbaker broke two of the facet joints in his spinal cord by pushing a Porsche 911. He had gone through three major surgeries, spent most of six years in bed and went through one doctor after another until he found Huff and a treatment that at least subdued his symptoms.

    "We had a life again. We were communicating again," said Thompson, who understands the need to stop addicts from taking opiates for the high. "But what about the people who really need (the drug)? Their families are being destroyed."

    Pipeline crimped by fear

    A growing number of doctors, usually anesthesiologists, specialize in patients like Wisenbaker. Many hospitals have special committees that set policies on alleviating intractable pain. California has a pain patients' bill of rights that legally establishes drugs derived from opium as a medical option.

    Still patients, doctors and advocates for the terminally ill assert pain is regularly under-treated, perhaps in part because it's subjective. Although advances are being made, doctors are limited in their attempts to scientifically measure pain. They have to rely on their patients.

    Wisenbaker said his pain feels as if he's in a vat of boiling oil and can't get out.

    Another woman on Methadone and Vicodin is just as colorful. She said it feels as if a claw is in her back, grabbing, twisting and squeezing.

    For Diana Thorp, a cancer patient from Ventura County, it was as if someone was pulling her arm out of its socket. The pain subsided as she was treated with a form of chemotherapy. At its summit, she would have tried anything.

    "I could not live the way I was living. I could not put on my clothes. I could not do anything," she said, suggesting it would be impossible to prescribe too high of a dosage. "People like me are going to die. We need the pain medication to add to our quality of life."

    The fear crimping the pipeline is multifaceted. Pain management experts say doctors worry about addicts posing as patients. They might worry too about state laws that require sending a copy of a prescription to the Department of Justice, wondering if what they consider an appropriate dosage might be viewed otherwise by health and legal authorities.

    The temptation is to leave pain untreated or prescribe drugs that are less effective but also less controversial.

    "Over-prescribing is not an issue," said Dr. Kaaren Douglas of Thousand Oaks, a family practitioner and regional leader of a patients' advocacy group called Southern California Cancer Pain Initiative. "Doctors under-prescribe. They don't over-prescribe."

    She backed up long enough to acknowledge a few doctors prescribe so much medicine their practice is a drug market. But she worries the attention focused on such cases obscures the crisis of untreated pain, the kind her husband, John B. Doyle, suffered after being diagnosed with cancer in June 1999. He died five months later, suffering for all but the last three weeks.

    "It keeps the fear in front of physicians that they're going to get prosecuted," she said. "Conflict makes drama. What gets the eye of people like yourself are the doctors who have done something obviously wrong. The other guys are trying to do a good job. They're just afraid. They don't want to take the risk."

    Some people blame the media or a lack of physician training. Others point at state medical boards and law enforcement.

    "This is part of the war on people who do drugs," said Dr. Robert Brody, chief of a pain consultation clinic at San Francisco General Hospital. "In their zeal to combat illicit drug use, the regulators ... have tilted way over and created an environment where physicians feel they have to be very, very, very careful before they respond to a patient's need."

    Seeds of addiction

    Extreme caution isn't a detriment when it comes to OxyContin, according to Elizabeth Willis, a chief in Drug Enforcement Agency's diversion control office in Arlington, Va.

    Painkillers like Percodan combine the opiate oxycodone with aspirin. OxyContin is pure oxycodone -- powerful enough that when swallowed as a tablet its medicine can work for 12 hours.

    "What is happening is that people are crushing the tablets and are snorting it and injecting it like they would heroin," Willis said. "They get a huge dose of the narcotic all at once."

    Addicts favor prescription drugs because they're reliable and sometimes are covered by insurance, Willis said. So they feign symptoms like a migraine headache and become "doctor shoppers," checking out one physician after another.

    But if some doctors are duped, others know exactly what they're doing, Willis said. They're pushers, just like people who sell cocaine or heroin.

    In Ventura County, the death of a 66-year-old man of an OxyContin overdose helped fuel an ongoing criminal investigation of Huff. The sheriff's department affidavit lists two other deaths related to drug use that are being investigated in connection with Huff's prescriptions.

    Sheriff Bob Brooks refers to the affidavit when answering questions about why his department is investigating a medical arena that many consider nearly as sacrosanct as churches.

    "When it's creating addicts and taking lives, it becomes a crime," he said.

    The sheriff's department has never pursued a case like Huff's before, Brooks said. But every year, the Medical Board of California receives an estimated 300 complaints about prescription abuses, the vast majority involving doctors who give out too much medication. About 25 of the cases lead to discipline that can be as severe as revoking a physician's right to practice.

    The state has investigated cases where aging doctors are duped by their patients, said David Thornton, chief of enforcement for the Medical Board of California. Sometimes, physicians are incompetent or motivated by money, in which cases they might sell prescriptions for as much as $50 a pop.

    "It becomes a public protection issue when the prescribing is at such a high level that essentially patients are becoming addicted and may have to go to detox programs," said Mara Faust, a California deputy attorney general who represents the state medical board in hearings.

    That happens often, said Dr. Robert Carvalho, addiction specialist and medical director of Vista Del Mar Hospital's psychiatric and rehabilitation program in Ventura. He sees more people hooked on OxyContin, Vicodin and other painkillers than anything other than alcohol.

    Far from being fearful of prescribing opiates, many doctors prescribe the drugs to patients with chronic but not intense pain when other less-addictive medications should be used, Carvalho said. And if a "patient" doesn't get enough drug from one doctor, he finds another physician who will provide a second prescription.

    "I think they're prescribed too frequently for the wrong reasons," he said, adding that he is not bothered by the prospect of medical boards and law enforcement peeking at prescription pads. "I think it's good to have some oversight."

    Julie Robinson doesn't know what to think. The Ventura County resident is a former patient of Huff's and said that she was simultaneously on 11 different medications for pain from her neck, shoulders and abdomen.

    "I felt like I rattled when I walk," she said.

    Robinson said she thinks the drugs caused her to fall asleep during a meal, her head dropping into her food. She ended up in the hospital on two occasions and in restraints once.

    Now she has switched doctors and has contacted a lawyer. But ask her if she wants law enforcement and medical boards to aggressively monitor pain management and her head shakes no.

    She worries doctors will become afraid to prescribe opiates and people like herself who have constant pain won't be able to find help.

    "I want people to have that option. But somehow there has to be a check and balance," said Robinson, trying and failing to work out the dilemma. "It's going to be very touchy."

    Walking the tightrope

    Doctors feel the whiplash, said Ann Kelley, an oncologist with offices in Ventura and Oxnard. Patients in pain push in one direction. Regulators shove back in the other.

    "We're kind of being attacked on both sides ... There's a tension shall we say," she noted.

    At least one pain patient said he could write a script detailing symptoms that would allow the healthiest person in the world to walk into a doctor's office and emerge with prescriptions for powerful painkillers. Kelley doesn't believe it but acknowledges being duped is a risk of dealing with pain patients.

    Still, doctors can't let such fears allow them to keep people in pain, she said. It's the same thing with the accusations against Huff.

    "It hasn't changed me or my practice," she said.

    Pain care advocates sometimes talk about the future as if it was an acrobat's high wire, explaining the need to balance a patient's right to the best medicine with a structure that reduces the chance of abuse.

    Sandra Johnson, a St. Louis law professor who heads a national pain management research project, calls for guidelines that judge doctors on the way they prescribe medication rather than just on the type and amount of a drug. She emphasizes the importance of record keeping and the need for physical examinations before making a prescription.

    "When physicians make those kind of efforts, they're very likely not to be prosecuted," she said, adding that when abuse happens, district attorneys and police should consult state medical boards before launching criminal investigations.

    California law requires doctors to have 12 hours of continuing education in end-of-life and pain-management care. The state also mandates that doctors use a triplicate prescription form when providing opiates to a patient.

    The form requirement has generated its own controversy and a state Senate bill to eliminate it. Among the concerns is that one of the three copies is sent to the state Department of Justice and constitutes a reminder of the threat of investigation.

    Representatives of the state medical board, the state Attorney General's Office and the federal Drug Enforcement Administration respond like a choir to questions about doctors being afraid to prescribe the right drugs. They said physicians who follow the law won't get in trouble.

    The fear is often based on rumor, added Thornton of the California medical board.

    "Physicians who are rightfully prosecuted tend to be very vociferous in their complete immunity," he said. "I think that fosters a lot of urban legends ... As long as (doctors) practice good medicine, they have no fear of any investigation."

    Some advocates suggest the medical board needs to show doctors that over-prescribing isn't the only offense that can bring investigation and discipline. They push for penalties for doctors who under-prescribe and laud the case being brought against a Bay area doctor for allegedly not doing enough to help a man with lung cancer.

    Douglas predicts that more and more patients will take matters into their own hands and sue doctors who don't prescribe the most effective painkillers.

    "They're going to demand better pain management," she said. "That's what is going to change the system."

    That Wisenbaker can be demanding when it comes to his pain is not an issue. But when he was worried about having to face his pain without medication, it was hard to know where to aim the demands.

    Doctors seemed scared to see him.

    He wrote to Assemblywoman Hannah-Beth Jackson but didn't hear back. He wanted to take action against a sheriff's deputy involved with the investigation of Huff but didn't know how.

    Finally, Wisenbaker got lucky. He talked to a pharmacist who referred him to a Los Angeles doctor who agreed to treat him. His medication patterns have changed, but at least he knows the pain won't go unabated. That's his priority.

    "What's important," he said, "is for me to get my medications and not to allow the pain to happen and screw up my marriage and screw up my life."

    Copyright 2003, Ventura County Star. All Rights Reserved.
    http://www.insidevc.com/vcs/county_n...003963,00.html

  2. #2
    Banned Acid's Avatar
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    What I ain't get is why a bunch do not even try if magically anything can be done. Not that I say can be in all cases, or so.
    But why not go to some magic professional (and that ain't mean idiots alike me), have them tune a while around in systems, figure out about aspects there a while, and at least have it tried out if something is going there.

    Might not make it all gone, but it some cases might make it go down a bit.

    What here is called Magie, has been used herealands and elseplace against pain, and maybe even longer than human written history reaches back.

    Can seem at times Westie scientists at times exaggerate a bitsy in their ignoring that there are research branches thousands of years older than them.


    I have not heard it used with SCI pains yet.
    But against headaches it is systematically used in differing cultures with high success (and on a level that's brain stuff, too), with injuries on the arms or legs, so why not spine?


    When I caught me a round of spinal pain in pic tunings with D.'s pic, among the first counters figured out was one aims sideways of them C regions into the neck, centers central focus for there, generates energy fields from there to extend direction them C regions, and uses these to down-regulate.

    At least for me that worked better than just phasing out of log.
    Just phasing out of log, left them pains lingering still for several minutes.

    Another method was centering right into such C with aimings,
    even if then pains first flare up quite a bit,
    and then regulating a while around.
    At the time I don't recall to have been out to try to make them disapparate entirely, as I had noticed they have reprogrammer considerations value for other stuff.
    Alike relevant indicators.
    I noticed this with C.R. pic games before. Though not as massively. (With his pics usually did not get it, anyway, just sometimes.)
    But seems there is some relevant use of pain, if regulating it down,
    but keeping it controlled just a little bit there.
    Alike a measurement factor for overloads and other stuff.

    Guess now maybe I might get alike stones thrown at me, or in this room stinking socks ( -> other thread in cure) for this, as I assume neither here nor within Magie the thought would be appreciated, to intentionally maintain pain levels to an extent alike measurement indicators for something else.


    (Maybe though, I am just barbarian in some opinions,
    and from a land, where already the old Romans regarded people as barbarians, gaving up trying to conquer them, and rather stuck up a defense wall, to have peace of them not just assenting to Roman methods.
    And am not that quickly deterred by some stuff. ;-))


    The barbarian

  3. #3
    Banned Acid's Avatar
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    Guess with a bunch of drug stuff, it works shortly, then receptor molecules alter numbers, to make up internal akasha balances errors caused by the drug messing into synaptic balances, and then effects of the drug are felt to go down. But as the receptor molecule numbers changed, the person got addicted.

    Hm, maybe this was simplifying it far too much.

    But might just land with some people sticking more and more direction kidneys of some stuff. And complaining it does not work anymore as the first time(s).
    Ignoring that on other levels, not just kidneys and receptor molecules, it might work far more than is good.

  4. #4
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    The trouble I seem to have with Doctors and pain seems to be prevelant in 3 areas:

    1. Many Dr.s don't see where the quality of life should take priority over their fear of getting their patients addicted. When the pain is ruining the patients life the patient is not worried about addiction.

    2. Most patients only use the opiate for pain and as long as that is true I don't believe you become addicted. I've gotten temporary relief from epidural pain block injections and cortisone in my shoulder and I have no craving for opiates and don't touch them when the pain is relieved. A doctor treating me refused pain meds telling me I'd be addicted. I fired him got another one who trusted me not to overdo them and I was made comfortable and left the hospital with no desire for pain meds when my need was over.My new Dr. said that severe chronic pain causes drug dependence, not addiction, just like a Diabetic is Insulin dependent.It's necessary for the well being of the patient.

    3. Some doctors have their favorite pain meds and don't listen to the patient regarding which meds work and which don't. I've had doctors who insisted on morphine or dilaudid when they do nothing for me. I literally had to be rude and ask my surgeon to tell the man that only Demerol works. One of my biggest beefs is Drs. who don't take into consideration the fact that patients usually know their own bodies.

    I wonder sometimes how much pain relief is covered in medical school.WR

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