Prescription drug abuse – Part II

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(Host) Prescription drug abuse is increasing dramatically. Eighteen people died in Vermont from overdoses of Oxycodone alone, the active ingredient in Oxycontin. In the second of a two-part series on prescription drug abuse, VPR’s Nina Keck reports on a new collaborative effort in Rutland that has doctors, pharmacists and law enforcement personnel working together to fight the problem.

(Keck) “Rick,” who asked that his real name not be used, has been clean and sober for 13 years. Before that, however, he was addicted to prescription drugs like Tylenol 3, Secanols and Valium. He says getting them from physicians in Rutland was easy.

(Rick) “Doctors are really dumb about addiction and they just don’t get it. They over prescribe and they re-addict a lot of addicts every year. I had a Physician’s Desk Reference in 1976 or ’77 and I would go through it to see what I wanted and go and tell them.”

(Keck) Rick says he’d also pay women to go to the doctor to get pain medications that he could later use or sell. Mike, a 27-year-old recovering addict in Rutland nods his head in agreement.

(Mike) “It’s easy. You can play a doctor. It’s not hard.”

(Keck) When one doctor refused to continue prescribing him narcotics, Mike says he’d simply shop around for another who would.

(Mike) “I could go to the doctor and tell them something was wrong with me. My back hurts, my leg hurts. It didn’t matter. I could go to the emergency room and say my tooth hurts and oh, okay, here’s a prescription of Tylox.”

(Sound of technician in an emergency room) “Okay, what I’m going to have you do is just try to relax your entire body…”

(Keck) In the Emergency Department at Rutland Regional Medical Center, staff says it’s a constant struggle to determine which patients are legitimately in need of pain medication and which are abusing the system. Emergency physician John Hartmann calls it a tight rope.

(Hartmann) “And the story might be, ‘I see Doctor X who prescribes my medicine. I won’t see him or her until next week and I’m out of my pain medications, I’m in horrible pain, please help me.'”

(Keck) Hartmann, like most physicians, says he wants to believe his patients and the vast majority of people he sees have legitimate problems.

(Hartman) “But it is hurtful when you find out after the fact you’ve been scammed. Because some of these people are good, some of them are very, very good.”

(Keck) Rutland surgeon Fred Bagley says doctors are not meant to be policemen. They’re sympathetic caregivers. And Bagley and others say doctors are much more sensitive to abuse than they used to be. But he says there’s been a growing sentiment among health care providers in Rutland that they need to do more about the growing prescription drug problem.

(Bagley) “Every drug bust in Rutland County – when they listed in the paper all the drugs that were recovered in the backseat of a car or in the apartment or whatever – All the street drugs were followed by a list of prescription drugs or narcotics. And it occurred to me that that gave a pretty sad impression of the physicians in Rutland County. If heaven forbid any of us were implicit or more likely, if we were just unwittingly being scammed time after time after time by people who were taking prescription drugs that we were prescribing in good faith and then selling them on the street.”

(Keck) So, Bagley, who’s president of the medical staff at Rutland Regional Medical Center, organized meetings with area physicians, pharmacists, hospital administrators and the police to find ways to help fight the problem. What they came up with is NAPP – the Narcotics Abuse Prevention Program. As part of the program, Bagley says area doctors will now be using tamper proof prescription pads to cut down on the more than 100 cases of forgery every year.

(Bagley) “We thought if we came up with a common prescription which had a lot of built in safe guards so that it couldn’t be copied, it couldn’t be forged, it couldn’t be altered. By having a uniform color and a uniform prescribing practice throughout the entire county that we would really tighten up access to narcotics.”

(Keck) Bagley says public education is also vital. Doctors need to more sensitive to abuse. He says they also need to make sure their patients understand how to use their pain medication and keep closer track of it. If you run out over the weekend, Bagley says, it’s now going to be much more difficult to get a refill. And he says if you no longer use your medication, flush it.

Rutland area pharmacies will be working closely with area physicians to ensure that the new prescription policies are followed through. Tamper-proof prescription pads are widely used in other states and appear to help curb forgeries. The next step, say NAPP organizers, is linking area pharmacies by computer so narcotic prescriptions can be better tracked. Kathy Keough is executive director of the National Association of State Controlled Substances Authorities. She says a program in Kentucky is especially good because it makes certain prescription information easily accessible to health care providers.

(Keogh) “So this is a way that they can look at their profile and say, ‘Hey, I was in Aruba that week and you say that I’ve had all these prescriptions written in this time period.’ And they can actually work hand in hand with law enforcement to identify potential problems.”

(Keck) Vermont does not currently have a prescription monitoring program. But John Dorvee, chairman of the Vermont Board of Pharmacy Practice, says they hope to within a year or two. Dorvee says Vermont would like to create a real-time database so that a physician or pharmacist can find out immediately whether there are problems with a given prescription. Unfortunately, he says, no working model for that exists yet. Until there is such a system, he says doctors and pharmacists will have to rely on their gut instincts when it comes to prescribing narcotics.

Dorvee says recent federal changes concerning the sharing of medical information have made that decision making process even harder.

(Dorvee) “Without a doubt, anytime there’s a suspicion of criminal behavior the privacy regulations go out and it opens the door for practitioners to talk amongst one another. However, until you know that it’s criminal behavior, are you then in violation of breaking the confidentiality in discussing an issue with a prescriber? It’s extremely difficult to know what to do.”

(Keck) And remember, Dorvee says, doctors and pharmacists are incredibly busy. When handling prescriptions, they have to worry about potential side effects and interactions with other medications, not to mention insurance policies. It gets tough, he says, if you also have to worry about whether you’re being conned. While NAPP organizers are cautiously optimistic about their efforts, they admit prescription drug abuse is a complex problem with no easy fix. Mike, a recovering addict in Rutland put it this way.

(Mike) “You can’t stop a drug addict, unless you stop making the drugs and then we’ll find something else. It’s not going to stop.”

(Keck) For Vermont Public Radio, I’m Nina Keck in Rutland.

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