Author: Justin Mckibben
These days it is pretty much impossible to In case you missed it, the latest news concerning opioid overdoses in America is not good. Just this week a report was released by the Center for Disease Control and Prevention (CDC) that only reminds us of just how horrific the opioid epidemic is. In most of the country, this crisis continues to get worse.
While we still don’t have a complete picture of the death toll in 2017 concerning opioids, the most up-to-date data shows that overdoses have spiked nationwide. Examining reports from hospital emergency rooms, the report compares the overall increase in opioid overdoses from the third quarter of 2016 up until the third quarter of 2017.
According to this data, opioid overdoses to increase by 30% in only a year.
Rising Overdose Rates by Region
In every age group, with both men and women, opioid overdoses are increasing, according to CDC Director Anne Schuchat. The Midwest has been the hardest hit region in that 12 month period. According to the CDC report:
- 7% increase in opioid overdoses in the Midwest
- 3% increase in the West
- 3% increase in the Northeast
- 2% increase in the Southwest
- 14% increase in the Southeast
All this may not come as much of a surprise for many Midwesterners. When you look at the last few years, the opioid crisis has not been kind to these communities. Of the counties with the highest overdose death rates per capita over the last few years, we consistently find some of the top spots going to states like West Virginia, Ohio, and Kentucky.
Needless to say, these devastating figures aren’t exclusive to the Midwest. A few more examples include:
- 109% increase of opioid overdose in Wisconsin
- 105% increase in Delaware
- 6% increase in Pennsylvania
- 34% increase in Maine
Luckily, not all areas are experiencing record highs. Some states are actually fortunate enough to see a slight decrease in overdoses, including:
- New Hampshire
- Rhode Island
Even in Kentucky, which has been a Midwestern state hit pretty hard over the years, the CDC analysis saw a 15% drop.
The CDC report does not specify as to why certain regions are experiencing overdoses differently, but one factor experts say has most likely played a key role is the availability of more potent opioids. The synthetic opioid fentanyl has been making its way onto the streets more and more over the last couple years, and supply of drugs like fentanyl has increased much faster in certain areas, which probably has a lot to do with the difference in overdose rates per region.
Analyzing Opioid Crisis
The recent report was meant to take a closer look at the opioid crisis by analyzing overdose reports in emergency rooms instead of opioid deaths like the CDC had previously focused on. CDC Director Anne Schuchat said these numbers lag behind the emergency room reports, and that the agency wanted “more timely information” to work with.
The data utilized for this analysis came from:
- Approximately 90 million emergency room visits
- Reports from July 2016 to September 2017
- 52 jurisdictions in 45 states
- 142,577 suspected opioid overdoses
That survey found an increase of 29.7% in opioid overdoses. The research also analyzed:
- 45 million emergency department visits
- Reports from July 2016 to September 2017
- 16 States
- 119,198 suspected opioid overdoses
This analysis shows a 34.5% increase during the same period, but those increases vary drastically from state to state.
At the end of the day, there are a lot of opinions on how to look at this mountain of information and see a way through it. But many experts are convinced that so far we have been failing those who are suffering the most. Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University, states:
“It is concerning that 20 years into this epidemic, it is still getting worse. The number of Americans experiencing opioid overdoses is still increasing.”
Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum, is one of many voices who are advocating for a more compassionate and supportive system. Those like Nickel believe that the key element to changing the opioid crisis is better integration of addiction treatment into a more comprehensive and effective healthcare system. Some, including Nickel, believe even emergency room staff should be better prepared to help get follow-up addiction treatment for people with substance use disorder.
Addiction isn’t going away anytime soon, and perhaps one of the most tragic parts of the problem is that so many people never get the help they need. Too many are afraid to ask for help, and plenty more still don’t know how to get help. Providing safe and effective substance use disorder treatment isn’t just useful, but vital to our future. So taking advantage of these programs and supporting expanded access to addiction treatment should be at the forefront of the conversation if we hope to break this trend and save lives. If you or someone you love is suffering from substance abuse or addiction, please call toll-free now. You are not alone.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
When discussing the very real devastation of the opioid crisis some people are still skeptical as to how big of a part prescription opioids play in the problem. While all patients should have access to comprehensive care for conditions relating to severe pain, ignoring the fact that prescription drug abuse is a crucial element of the epidemic is far too careless.
Many states had to face the issue of pill mill clinics and doctor shopping. Now one state, in particular, is now taking massive action in hopes of ending a very serious problem that has only grown over the years. Authorities in North Carolina took a close look at how prescription drugs wind up on the streets.
One of the key factors to narcotic medications hitting the illicit market was doctor shopping.
Doctor Shopping Stats
First, let us explain what doctor shopping is for those unfamiliar with the concept. Innovations in Clinical Neuroscience described the practice of doctor shopping, saying it:
“- entails the scheduling by patients of office visits with multiple clinicians for the same agenda, either for a continuing illness or to procure prescription drugs illicitly. As expected, the explicit definitions in the literature vary considerably, with a significant proportion focusing on a given illness episode.”
Essentially, doctor shopping is when patients visit multiple doctors with the intention of having a prescription given and then filled from each physician, giving them an abundance of medications.
Now in the case of North Carolina, this tactic grew a great deal of momentum as the opioid epidemic spiraled out of control in the past few years. According to WRAL, a Raleigh-based news outlet:
- In 2010, the State Bureau of Investigation says there were 88 doctor shopping cases.
- In 2016, that number rose to 184
- That is a 110% increase in doctor shopping incidents!
According to NBC Charlotte:
- Approximately three people North Carolina die every day in due to drug overdoses.
- Around half of those deaths are due to opioid painkillers.
So now, what moves is North Carolina making to try and fight back?
The Strengthen Opioid Misuse Prevent Act
After realizing just how big of an issue prescription drugs were playing into their current drug problem, officials in North Carolina have decided to put measures in place to try and prevent doctor shopping.
Starting January 1st with the new year, North Carolina enacted a new law, referred to as the Strengthen Opioid Misuse Prevent Act. So what does this new measure do?
- It allows doctors to only give a five day supply of opioids for pain from certain injuries, like broken bones.
- After a surgery, it allows doctors to prescribe a seven day supply.
- Refills can be given as needed, but the first refill will be limited.
North Carolina also gave some thought to protecting those in severe need of pain management resources. The new law does not apply to those with:
Local Authorities Unsure of the Future
The executive director of the North Carolina Board of Pharmacy, Jay Campbell, told reporters that while the action is being taken, it will probably never be completely eliminated. Campbell states,
“We’re certainly hoping that we can radically reduce the scope of drug diversion from pharmacies or any place else. But it is a problem that is never going to go away.”
However, Campbell believes there are certain indications of doctor shopping that pharmacists can keep an eye on as well, such as:
- The patient is visiting a pharmacy far outside their normal location.
- The patient brings in prescriptions from doctors the pharmacy is not familiar with.
Officials trying to stop doctor shopping in the area are asking pharmacists to be alert and ask questions when appropriate. Meanwhile, they are also working to develop other means of drug monitoring, including a system in which North Carolina doctors can register when they prescribe opioids to monitor records and catch patterns of doctor shopping.
There may now be some light at the end of the tunnel. Overdose death rates due to many legal prescription opioids are still rising, but they are rising far more slowly than that of fentanyl and other synthetic opioids according to a CDC report. While it is terrible that the death rates are still increasing, the fact that the rate of progression has slowed noticeably could suggest that many of the recent efforts aimed at curbing widespread over-prescribing practices could be starting to have a positive impact on the extent of the opioid crisis.
Medical Detox for Opioids
An important thing to remember is that for those suffering from substance use disorder or a physical dependency to opioids should always seek safe medical treatment in order to get off these powerful drugs. Opioid abuse presents an inherent risk to the body and the brain. Because of the often difficult and uncomfortable withdrawals, detoxing from opioids is best done in a safe medical environment.
Palm Healthcare Company’s detox facilities will offer a more comprehensive model for recovery from opioid addiction. Medical detox consists of both psychological treatment from professionals for both addiction and co-occurring mental health issues, as well as pharmacological treatment from medical specialists who can decide if there are optional medications to help ease the detox process.
What a medical detox for opioids should always do is provide a trained staff to monitor important vital signs like:
- Respiration levels
- Blood pressure
- Body temperature
- Heart rate
Abruptly discontinuing opioids can be painful or even damaging to the body. Make sure to seek the appropriate help. If you or someone you love is struggling, do not wait. Please call toll-free now. You are not alone.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Despite the fact that over 91 people die every day from an overdose due to prescription drugs, some people still struggle to realize that prescription drug abuse is the driving force behind the current opioid epidemic. According to the American Society of Addiction Medicine (ASAM):
- 4 out of 5 heroin users started out abusing prescription pain medication
- 94% of people in treatment for opioid addiction surveyed in 2014 switched to heroin from prescription opioids.
One of the biggest issues is that powerful opioid painkillers are being overprescribed. Whether due to aggressive marketing tactics used by Big Pharma companies or the corrupt ‘pill mills’ where doctors were dishing out excessive prescriptions of potent drugs to be sold on the street, prescription opioids flooded the neighborhoods across the nation, helping create one of the worst addiction outbreaks in American history.
But it wasn’t just the fact that drugs were making it onto the streets. In general, even legitimate opioid prescriptions were astonishingly high. While too many people still think the only problem is heroin or street drugs, the facts show us that opioid painkillers were still largely overprescribed in recent years, which contributed to the current crisis.
Too ‘Legit’ to Quit
According to the National Survey on Drug Use and Health, nearly 92 million U.S. adults in 2015 were taking a legitimately prescribed opioid. That translates to 38% of the adult American population.
There were an estimated 240 million opioid prescriptions in 2015, nearly one for every adult in the general population. Even the Deputy Director of the U.S. National Institute on Drug Abuse, Dr. Wilson Compton, said,
“The proportion of adults who receive these medications in any year seemed startling to me”..”It’s an awful lot of people who take these, mostly for medical purposes, but within that, a significant percentage end up misusing them,”
So while a lot of these prescriptions were going to treating serious conditions, how many ended up on the street or being abused at home because they were overprescribed?
The same NSDUH survey found that 11.5 million people misused prescription opioids they obtained through illicit means. Overall, Dr. Compton states that these results indicate medical professionals are doing a poor job of appropriately prescribing these medications.
The trend didn’t end there. According to a new report, nearly 3 million people who had surgery in 2016 became persistent opioid users, taking the drugs 3-6 months after a procedure. The report also states that due to overprescribing, 3.3 billion pills were left unused by patients, which left them open for diversion or misuse.
Some pain management advocates insist that pain may end up being undertreated due to the rising scrutiny of opioid prescriptions. Many of these advocates say it is extremely difficult to truly know if opioids are overprescribed because pain is too hard to objectively quantify. Therefore, some patients may actually need more relief resources than others.
Yet, prescribing rates are still, at the very least, questionably high. Especially considering by most estimates that over 50% of opioid pills legitimately prescribed are unused by patients, which suggests significant overprescribing certainly exists.
4 Doctors, 6 Million Pills, 1 Year
One recent case in particular that stands out concerning overprescribing of medications is the story of a small northwestern county in Arizona where 4 doctors prescribed nearly 6 million opioid pills in a 12 month period. The data provided by the Controlled Substances Prescription Monitoring Program did not list the doctors by name, but did give detailed information about the prescriptions.
Out of all 4, the top prescribing doctor is responsible for:
- More than 20,000 opioid prescriptions
- Equaling out to over 1.9 million pills
- That comes to 7,350 pills a day
The second-place prescriber is responsible for:
- More than 15,000 prescriptions
- Equaling out to nearly 1.6 million pills
The other two doctors totally a combined 2.4 million pills prescribed.
The four doctors in question are located in Mohave County, which as of 2016 is home to approximately only 205,249 people. That comes out to about a 30 opioid supply for every single person in that county.
Now while pain may be hard to objectively quantify, these numbers are obviously unsettling. Even the executive director of the Arizona Board of Pharmacy, Kam Gandhi, could not explain why or how these four physicians were able to issue so many opioid pills.
A spokesperson for Attorney General Mark Brnovich declined to specify exactly what actions are being taken by his office concerning this development. However, according to AZ Central Doug Skvarla, who directs the Controlled Substances Prescription Monitoring Program, said that information has been passed on to Brnovich’s office for “an open investigation.”
Illicit Use of Prescriptions
There are plenty other issues with opioid prescriptions being taken advantage of all over the United States. Pain management advocates often argue that the problem isn’t about opioid prescriptions; it’s the people that misuse and divert the medications. In other words, that the people abusing opioids frequently don’t have a legitimate prescription. A lot of opioid pills being abused are obtained illicitly.
Many people won’t use their whole prescription. Many will actually give pills to a loved one who doesn’t have their own pain treatment. Or they will sell their remaining pills. Pill mills and ‘doctor shopping’ allowed for the even worse spread of excessive opioid prescriptions. Like in Illinois, where one individual received 73 prescriptions for opioid drugs from 11 different prescribers and filed them at 20 different pharmacies. In some cases, the individual filled prescriptions at multiple pharmacies in one day.
There is absolutely a high demand on the illegal drug market for prescription opioid painkillers. As a former addict who spent over 7 years using, buying and selling opioid medications on the street, I can say there is plenty of ways to get these drugs without a prescription.
However, if we back-track a little bit, how did so many potent medications get onto the streets if there is no overprescribing?
Feeling the Pain
Pain management is absolutely necessary. There must be resources and effective medications available for those suffering from serious medical conditions or recovering from life-altering procedures. There is no denying that we have to provide effective pain relief options for patients who desperately need it. So, of course, this is a difficult conversation to have, because many people can take these medications are directed and be fine when they are gone. Some people require long-term pain treatment, but it does not result in a severe addiction.
Still, the fact is that if these medications weren’t being prescribed more than medically necessary, they would have never flooded the underground drug marketplace as rapidly and as abundantly as they did. Between doctors overprescribing (sometimes for kickbacks), patients working the system and manipulating physicians, and the aggressive marketing tactics of Big Pharma going unchecked, there are plenty of elements at play.
Undoubtedly when we examine the opioid epidemic we cannot ignore any contribution. We have to make efforts to combat the spread of heroin addiction. There has to be an intensive effort to deal with the incredibly deadly synthetic opioids like fentanyl and carfentanil, and people also have to acknowledge their own choices and do their part to move forward. It might be a difficult and painful process, but it is necessary.
Still, overprescribing of opioid medications cannot be ignored. We should explore all options concerning prescription monitoring programs, enforce current regulations of drug distribution, and develop innovations in pain management therapy.
According to one report, even just a 10% reduction in surgery-related opioid prescribing would reduce:
- The number of excess post-surgical pills available for diversion or misuse by 332 million
- The annual number of patients who go on to persistent opioid use after surgery by 300,000
- Annual drug costs by $830 million
Not only can we do better to treat those suffering from chronic and severe pain, but we can do better to make sure these potent and habit-forming medications don’t end up in the wrong place. For those who abuse prescription opioids, or who have found themselves using heroin, we need to provide safe and effective treatment options. Palm Partners Recovery Center has been treating people struggling with drug dependence and substance use disorder for decades, focusing on holistic and comprehensive care. If you or someone you love is struggling, please call toll-free now.
CALL NOW 1-800-951-6135
Author: Justin Mckibben
Ever since the true nature of the opioid epidemic in America began to come to light, and people started to see the gravity of its impact in communities across the country, there have been plenty of efforts to find out how we ever got this far. We continue to ask who should be held accountable. Was it the black market drug trade? Was it the synthetic opioids coming from overseas? How did it get this bad?
Just this past week 60 Minutes and The Washington Post joined forces to interview Joe Rannazzisi, who is said to be the most important whistleblower ever on 60 Minutes.
Joe Rannazzisi is a former agent of the Drug Enforcement Administration (DEA) who ran the Office of Diversion Control; the department in charge of regulating and investigating the pharmaceutical industry. He is a former DEA deputy assistant administrator with a law degree, and a pharmacy degree, who believes the great injustice done to the American people cannot go overlooked.
Bad Business with Big Pharma
Through this inside look with Rannazzisi, he implicates Big Pharma drug makers in willingly distributed hundreds of millions of drugs to rogue pharmacies and pain-clinics-turned-pill-mills for over two decades.
Rannazzisi believes that the Big Pharma companies, some even multi-billion, Fortune 500 companies, have contributed to the problem by ignoring the truth; that powerful prescription pain medications were being diverted from doctors, clinics and pharmacies for illicit use. In the interview, Rannazzisi calls out a number of key drug makers, including:
He also calls out the three largest drug distributors:
- Cardinal Health
Saying they control probably 85%- 90% of drugs “going downstream.”
In fact, Rannazzisi said the way pain clinics seemed to pop up overnight all over the country made the whole crack-cocaine epidemic look like nothing, saying he had never seen anything like it, adding:
“These weren’t kids slinging crack on the corner. These were professionals who were doing it. They were just drug dealers in lab coats.”
Rannazzisi says after prosecuting pain doctors and pharmacists didn’t seem to put a real dent in the problem, he knew he had to work his way up; they went after distributors.
While drug distributors tried to defend themselves saying it was all on the doctors for over-prescribing medications, Rannazzisi says they know exactly how many pills are being sent out. Under the Controlled Substances Act, these distributors are required by law to report and stop what the DEA refers to as “suspicious orders”.
So what might “suspicious orders” look like? Probably something lie unusually large and/or frequent shipments of opioids being made to a location. Kind of like what was happening all over the nation for years and years.
For example, just one pharmacy in Kermit, West Virginia ordered 9 million hydrocodone pills in just over 2 years. That’s for a town of only 392 people. That’s over 11,479 pills a person each year! Almost 1,000 pills a month! From only one of the town’s pharmacies.
DEA investigators say many drug distributors ignored the DEA requirements and shipped anyway.
DEA Fighting Back
Rannazzisi wasn’t the only DEA agent to speak up about Big Pharma’s bad business. Several other DEA veterans say they saw thousands of suspicious orders and tried to fight the growing problem. Others said they tried on multiple occasions to get these companies to fix the issue, but they did nothing.
Eventually, in 2008 the DEA was able to hit some distributors with hefty fines for filing hundreds of suspicious orders, including:
- $13.2 million fine against the country’s largest drug distributor, McKesson
- $34 million fine against second-largest distributor, Cardinal Health
The fines for drug distributors over the last 7 years add up to around $341 million.
The High Rollers
In 2011, Cardinal Health attorneys called Rannazzisi’s boss at the Justice Department, who called Rannazzisi and pressed for an explanation for his policies. Rannazzisi believes that even after they had gone after small companies hundreds of times before, as soon as they went after the Fortune 500 drug makers, their power and influence started getting in his way.
Rannazzisi says that with these massive Big Pharma empires there was now money and influence being used to pressure top lawyers at the DEA to pursue a softer approach on penalizing drug distributors who broke the rules.
Former DEA attorney Jonathan Novak noticed that shocking shift in the way these kinds of cases were handled. Stating:
“These were not cases where it was black — where it was grey… These were cases where the evidence was crystal clear that there was wrongdoing going on.”
But suddenly the higher ups started to demand more and more evidence to stall the system. Fewer cases against Big Pharma companies were being approved, and road-blocks from Novak’s bosses seemed to pop up everywhere.
Novak also said he saw a huge migration of DEA lawyers switching sides to defend the drug industry in higher paying positions.
Taking it to Congress
While drug distributors started successfully stalling the progress of cases against them from the DEA, they also began to lobby Congress to get legislation that would destroy the DEA’s power over them.
Then one day Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee introduced a bill to the House that was promoted as a way to ensure that patients had access to the pain medication they needed. However, Jonathan Novak, who worked in the DEA’s legal office, claims that what the bill really did was strip the agency of its ability to immediately freeze suspicious shipments of prescription narcotics to keep drugs off U.S. streets.
The bill’s author… Linden Barber, a former employee of the DEA.
Congressman Tom Marino, along with Congresswoman Blackburn, later wrote the inspector general for the Justice Department, demanding that Rannazzisi be investigated for trying to quote “intimidate the United States Congress.” Even though this went nowhere, Rannazzisi was stripped of his responsibilities soon after.
Some former DEA agents believe that the Big Pharma industry not only used lobbying groups to donate money to politicians to get laws passed in their favor, but also to try and push Joe Rannazzisi out of his office.
In the end, the DEA signed off on the final version of the “Marino bill.” A senior DEA representative claiming that even though they fought to stop it, growing pressure from Congress and industry lobbyists forced them into a deal it did not want.
The bill was presented to the Senate in March of 2016.
Majority Leader Mitch McConnell introduced the legislation in the Senate.
It passed by unanimous consent with no objections and no recorded votes.
It passed the House the same way, and President Obama signed it into law.
Where Are We Now?
This whole thing reminds you of the saying- if you can’t beat em, join em.
It would seem that’s exactly what a lot of DEA agents did after fighting a losing battle against powerful Big Pharma companies.
Since it all began, the pharmaceutical industry and law firms that represent them have hired at least 46 investigators, attorneys, and supervisors from the DEA, including 32 directly from the division that regulates the drug industry.
Remember that guy Linden Barber, who authored the bill that many say stripped the DEA of the power to go after Big Pharma companies? Well 3 months ago Cardinal Health, that second-largest drug distributor we were talking about that went after Rannazzisi through his boss, hired Linden Barber as the senior vice president!
Other former DEA agents and lawyers have gone on to take up so pretty prestigious positions working for drug companies, or law firms and other organizations working in the pharmaceutical industries best interest.
Joe Rannazzisi now consults with state attorneys general who have filed suit against distributors for their role in the opioid crisis.
Oh… and let us not forget Congressman Marino, who was just nominated to become President Trump’s new drug czar.
Remarkably, there are a lot of instances of people in the DEA being influenced by pharmaceutical companies and lobbyists to stand up for drug companies instead of the tens-of-thousands of Americans dying from opioids each year. In many of these instances, the individual’s go on to get high-earning jobs defending the interests of the Big Pharma industry.
So is it a made-up conspiracy? Or are pharmaceutical companies buying their way out of trouble at every turn and pushing out people like Rannazzisi who stand up to them? Is it really that hard to believe when you connect the dots?
With an ongoing opioid epidemic doing major damage to the country, we have to acknowledge everything that has contributed to this issue. Even if we set aside the idea of placing blame, we cannot prevent it from getting worse or happening again if we don’t acknowledge what helped cause it. Every drug company, policy maker, pharmacy, crooked doctor and individual should be accountable to taking action to make things better. It starts with accepting the issue and building a foundation to recover. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-800-951-6135
Author: Shernide Delva
The opioid crisis is pinpointed to a variety of sources, yet those blamed the most are doctors. Doctors are criticized for their generous prescribing of prescription painkillers that led to patients developing an addiction to the drug. Drugs like oxycodone were for a long time easily prescribed until recently. Once the prescription drugs became more difficult to obtain, addicts turns to heroin thus resulting in the shocking epidemic we are in today.
However, there is more to the story. Turns out, patient satisfaction surveys may be another major part of the puzzle. These surveys continue to influence doctors today. To understand the problem, you have to understand the influence these surveys have. Doctors incomes are based on survey scores, and patients who are not given a desired prescription leave doctors a low score on their satisfaction surveys.
The Opioid Crisis: Behind the Scenes
An article published in The Fix explained the behind the scenes in hospital emergency rooms. ER doctor of osteopathic medicine Gerald O’Malley opened up about what he considers to be the biggest culprit in the opioid crisis. With over 25 year of experience, he understands the depth of the epidemic from a medical point of view.
The culprit is the hospital satisfaction surveys mandated by the Centers for Medicare and Medicaid Services (CMS). CMS is a government organization that dictates payment for medical surveys and sets the agenda for the entire insurance industry.
The problem with these surveys is that they contradict the doctor-patient relationship dynamic. Instead of the relationship being about trust and integrity, it becomes about the doctor pleasing the patient for improved survey scores. The physician no longer is an adviser, but a corporate spokesperson. Hospital administrations hand out scripts to memorize and recite.
“We were told to say, ‘Hi, my name is So and So, and I’ll be your doctor today,’ and ‘Please let me know if there’s anything we can do to make your experience here more pleasant.’ It was incredibly insulting to me, and what you’d expect from a waiter or electronics salesman,” said O’Malley. “I like to treat people as individuals, not somebody who came to the ER to spend money.”
At Albert Einstein Medical Center in Philadelphia, O’Malley described a common scenario where staff were routinely lectured by the department chairperson. They were told their survey scores would be judged and to be aware of the consequences of low performance.
“Then, just to be dramatic, I guess, the chair quoted a line from The Godfather,” said O’Malley. “He said, ‘This is the business we’ve chosen.’ Which meant, if you don’t like it, get out.”
What the Surveys Require:
The expectations to earn a high score on these surveys have little to do with a doctor’s ability to take care of a patient.
“It had nothing to do with medical care,” said O’Malley.
Instead, the surveys instill behaviors such as having staff knock on doors and introduce themselves. Doctors also must accommodate the requests of their patients.
“We had to allow as many people into the room if they requested it. One time there were five family members; two in wheelchairs. There was literally no way for me to get to the bed. I had to play traffic cop and say, ‘I’m sorry, I understand you all want to be here but I need to perform an exam so some of you have to leave.’
Seems like an appropriate request from a doctor attempting to do their job, however administration does not see it that way.
“That kind of honest, blunt conversation was frowned upon by the administration. They don’t practice medicine so they don’t understand that it’s fucking impossible to try to talk to someone about anything sensitive. They may not want their family members to know what drugs they’ve taken. But asking everybody to leave is uncomfortable.”
In addition, these surveys request that medical personnel sit during consultations. Studies show that sitting down makes customers feel like their physician is with them longer. That sounds manipulative because it is, but O’Malley says the point is to give customers the perception of good care. Moods matter too. Medical personnel are to maintain their energetic demeanor despite physical exhaustion from working long hours.
Drug Abusers: Doctors Struggle to Do the Right Thing
When it comes to patients seeking narcotics, their opinion of their doctor will largely relate to whether they leave with a prescription. Unfortunately, doing the right thing in this situation can negatively affect a doctor’s survey results and stir up conflict.
“They’d walk in and say, ‘I need two milligrams of Dilaudid 4 with 25 milligrams of Phenergan,’ and, ‘Come on, chop, chop, let’s go. Snap to it.’ Or they’d say, ‘I’m going home now, so I need a prescription for 50 tablets of oxycodone.’ After looking up their records in the computer, I’d have to say, ‘Hang on, you just got a prescription for 50 tablets of oxycodone last week.’
“Then suddenly, you’re in a confrontation. The patient is yelling ‘I want to speak to your boss!’ If it’s 2:30 in the morning, I was the most senior person there. In those circumstances I knew this was somebody abusing oxycodone or selling it in a school playground somewhere. So then it’s ‘What do I do now?’ Did I really want to deal with this for the next two weeks, having to explain why this guy got so pissed off and gave me bad survey numbers?”
In situations like these, doing the right things becomes a difficult decision. It is easy to see why doctors sometimes choose the easier route of prescribing the requested meds. Emergency room visits are skyrocketing because of lack of healthcare. Many addicts go to ERS because they are open 24 hours.
“I had a guy show up at three in the morning with a herpes outbreak. He said, ‘I need Acyclovir and Zovirax cream.’ Okay, that made sense. But then he said, ‘I need something for the pain—Percocet or Vicodin or Dilaudid.’ I go, ‘Dude, you’ve got herpes. It’s not like a broken leg.’”
Making Difficult Decisions
When the patient is denied their prescription, they may soar into a roaring fit, demanding to speak to higher authority and provoking further conflict. Sadly, it is easier for some doctors to decide to not do what is right, but what is easier. After all, their survey scores are sent to the CMS who use those scores to distribute reimbursements.
“Look,” said O’Malley, “we have certain metrics we have to meet. If CMS doesn’t like our scores, then, guess what? They’re not going to reimburse us. We’re going to be out money.”
Even when doctors tighten up on prescribing painkillers, it leaves behind those who need them most: chronic pain sufferers. Dr. O’Malley admits when a chronic pain sufferer comes into the ER late at night requesting a prescription for an opioid, it puts him in a difficult position.
“I’ve never seen them before. I don’t know if the stuff they’re saying is true. I don’t want to see people in pain but I have a social responsibility not to contribute to this opioid epidemic. They say, ‘I don’t care about your social responsibility. I want my narcotics NOW! If I don’t get them I’m going to slam you on your evaluation.’”
When it comes to administering Narcan (naloxone), Dr. O’Malley sees the increase availability of Narcan as a positive force in the opioid epidemic. When doctors revive patients, they often become belligerent with medical personnel.
“They jump off the bed, and run out of the ER. That is terrifying. Narcan is only going to last 20 to 30 minutes. If they overdosed on opioids like methadone or oxycodone they’re going to go back into respiratory arrest, or pass out at the top of a staircase, or get behind the wheel of a car.”
Sadly, the epidemic is only getting worse. The worse part, O’Malley says, is having to tell families their children have died because of an overdose. Therefore, despite the consequences of bad survey scores, it is important all doctors take a stand in preventing the amount of overdoses reported annually in the United States. They must do the right thing.
Every 19 minutes, someone dies from opioids alone. The opioid crisis is complex and it may take time to figure out the right solution; however that does not mean you should give up. Treatment is critical and if you or someone you know is currently struggling, the time is now to seek treatment. Do not wait. Seek treatment today.
CALL NOW 1-800-951-6135