WHAT ROLE DO DOCTORS PLAY IN DRUG ADDICTION and/or ABUSE

http://www.daytondailynews.com/news/dayton-news/what-role-do-doctors-play-in-addiction-abuse--708971.html?showComments=true


Exclusive Investigation Drug Overdoses

What role do doctors play in addiction, abuse? Improper Rx’s lead to arrests, state sanctions

By Anthony Gottschlich, Staff Writers Staff Writer Updated 12:48 AM Sunday, May 16, 2010 DAYTON DAILY NEWS


DAYTON — The list of relatives lost to drugs is a long and painful one for Becky Brunotte of Dayton.

A brother in the 1990s, a sister five years ago and a brother-in-law the following year. But the deepest blow came in early 2006, first when her son-in-law, Fred Bailey, died from a methadone overdose in Dayton that February, then when her daughter followed less than six weeks later, also from a methadone overdose.

Erika Bailey was 32, the mother of three children and Brunotte’s only daughter. While Brunotte acknowledges her daughter had a drug problem, she blames Erika’s doctors, too.

“Two weeks after Fred died, (his) doctor prescribed my daughter the same prescription,” Brunotte, 58, said from her Wyoming Street home, her voice rising in anger. “She had doctors giving it to her right and left. All she had to do was ask.”


‘Fifth vital sign’

Local physicians acknowledge bad doctors and inappropriate prescribing contribute to illicit drug use, but most doctors are trying to serve their patients and ease their suffering.

“It is extremely difficult to try to discern who is an absolutely legitimate person suffering with an acute or a chronic physiological pain problem that will utilize their pain medications in an appropriate fashion to control their pain symptoms,” said Dr. Townsend Smith, director of pain services at Miami Valley Hospital. Smith said the whole medical culture has changed over the past 20 years. Patients are more demanding, he said, and pain, once recognized as an undermanaged issue, is now seen as “the fifth vital sign.” As a result, doctors are writing prescriptions for pain medication more liberally these days.

Like Smith, Dr. Amol Soin of the Ohio Pain Clinic in Centerville, Beavercreek and Wilmington said it’s his policy to not prescribe narcotics upon a patient’s initial visit to his office. Patients sign agreements that they won’t divert or abuse their medications, and he administers drug screens, counts their pills and employs other measures when he suspects illicit use.

“Sometimes, unfortunately, because these medications are highly addicting, are we really helping them? Are they coming in with one problem, pain, and then leaving with two problems, pain and an addiction to a medication? That’s a tough thing,” Soin said.


‘Doctor shopping’

Smith and Soin said they try to prevent “doctor shopping” — the practice of visiting multiple physicians and dentists to acquire drugs, either for abusing or selling — by running their patients’ names through the Ohio Automated Rx Reporting System.

Created by the Ohio Pharmacy Board in 2006, the online database provides prescribers and pharmacists a patient’s prescription history so they can check the patient’s use (or misuse) of controlled drugs. However, it can take up to two weeks from the time a patient fills a prescription to when it shows up in the database.

Also, the system is voluntary. So far just 13 percent of the state’s 42,000 licensed physicians and dentists have registered to use the system, according to the pharmacy board.

The problem was highlighted recently by the case of a 31-year-old Troy man who obtained 62 prescriptions from 49 doctors. Those prescriptions were filled at 30 pharmacies between October 2008 and October 2009 across the region.

According to the pharmacy board and state health department, 16 percent of those who died of unintentional drug poisoning in 2008 had “doctor shopped.” The rate was 18 percent for the central and northern Miami Valley; 21 percent for the southern Miami Valley, tied for highest in the state.

Last month, Gov. Ted Strickland called for more doctors, dentists and pharmacists to use the prescription tracking system. He also called for the licensure of pain clinics. While many pain clinics are legitimate operations that help clients cope with chronic pain, others act as so-called “pill mills,” dispensing drugs indiscriminately in order to profit, he said.