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
Some serious justice has been dealt this month as another crooked “pill mill” doctor has been struck with a serious of guilty verdicts for his participation in the illegal enterprise of over-prescribing patients shopping for dangerous opiate painkillers.
In a Palm Beach County courtroom earlier in November Dr. Barry Schultz stood in a frozen stare as the word “guilty” was read out 55 times pertaining to charges brought against him. Each sentence was assurance that Schultz would be serving at least 25 years in prison for his pill mill drug trafficking activities.
This is just one story out of so many similar instances across the country where doctors essentially ran illegal drug dealing operations out of their offices and clinics, writing prescriptions for addictive and deadly drugs to people who didn’t need them, fueling the opiate painkiller abuse issue that made a devastating contribution to the opiate epidemic.
The Case and the Charges
Barry Schultz is a 59-year-old former doctor of the suburban Delray Beach, Florida area. During the trial brought against him Shultz claimed he had been pumping out the obnoxious amount of prescriptions for massive quantities of oxycodone and other narcotics to help people in chronic pain. Since the verdict Shultz was shipped off to Palm Beach County Jail to await sentencing set on January 8th.
During the trial, Assistant Palm Beach County State Attorney Barbara Burns and prosecutor Lauren Godden said Schultz prescribed as many as 20,000 pills a year to patients without medical justification. Barbara Burns retired after spending 25 years as a county prosecutor with this case marking the end of her career, showing that she finished strong.
Schultz carried out his illicit operations from the pharmacy out of his office on Jog Road. Prosecutors refuted his claims of trying to help people with pain by stating he was simply greedy, and eventually it caught up to him. The pharmacy only accepted cash, and it was estimated by Burns that on a weekly basis it was raking in about $10,000!
That is a lot of chronic pain.
The jury that heard Schultz’s case deliberated for roughly 17 hours over a three day period before announcing the verdicts. Schultz escaped a few of the charges, which came to about 19 of the 74 drug trafficking charges he initially faced, but the other 55 are nothing to be overlooked. At least 20 of the 74 chargers are all punishable by mandatory 25-year prison terms, so Shultz is sure to be getting more than enough time to spend reflecting on his crimes.
Schultz’s attorney declined comment. But the show isn’t quite over for Schultz. He was stripped of his medical license, and now also faces a charge of manslaughter for causing the overdose death of a 50-year-old patient in 2010. The pieces of the pill mill seem to have fallen apart and are now piling up on top of this crooked doctor as the prosecutors aim to make this case a staple in the fight against drug trafficking and opiate addiction.
This county is full of doctors who have been prosecuted in recent years as pain clinics created a health crisis throughout the state. Doctors have plead guilty to a variety of related charges, including wire fraud, while others were convicted of other charges.
Schultz’s attorney tried to use the pain clinic crackdown to persuade jurors that Schultz was the victim of a witch hunt. Schultz said he became attracted to the potential benefits of narcotics while working as a hospice doctor and treating the elderly, and stated he was only doing what he thought was right to assist his patients. It is expected that Schultz’s legal team will appeal the verdict on these grounds.
Either way, it would seem that the state of Florida is attentive to the issue with prescription pain medications being sold to the highest bidder by doctors who knowingly supply the drugs for them to be abused, taking it very serious and actively trying to bring down those who are trying to profit from pill mills. Making money off of the pain and suffering of sick people is no joke, neither is a 25 year sentence for drug dealing out of a pharmacy. Sooner or later it all catches up.
Battles against prescription painkillers and the doctors running the pill mill empires seem to still be making waves. There are still thousands of addicts and alcoholics seeking help. But there is hope, and it can be as simple as a phone call. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135.
Author: Justin Mckibben
Southeastern Indiana has been battling the prescription painkiller problem for some time, and for a second it seemed that heroin was outdoing opioids as the drug of choice and the pill issue was in decline. Then this past Wednesday news from state health officials changed all that optimism when people were informed that at least 26 people in the region were diagnosed with HIV in just a 3 month period, and most of them contracted it after injecting drugs, but not the heroin they thought they were dealing with, but Opana, another potent painkiller.
Record Numbers of HIV Cases
The first case that has been included in the outbreak in southeastern Indiana was diagnosed in early December according to the deputy commissioner and director for health outcomes at the Indiana State Department of Health Dr. Jennifer Walthall.
By January 23rd the total of newly diagnosed HIV cases jumped to 11, and in a region that typically experiences less than 5 new cases annually that was a big eye-opener. Since then, more cases have been diagnosed in several counties, and officials are troubled.
These cases, not to mention 4 others considered preliminary cases, could be the start of a whole new problem for the people of Indiana. State health officials are interviewing newly identified HIV patients and urging them to reach out to their sexual partners as well as anyone with whom they shared needles, as both forms of contact can spread the disease.
During their investigation into the outbreak, officials found those infected with HIV, the virus that causes AIDS, had injected Opana. State health officials say it is not a common occurrence that prescription drug abuse has sparked an HIV outbreak, and Dr. Melinda Campopiano, a medical officer with the federal Substance Abuse and Mental Health Services Administration, agreed in a statement.
“I am not aware of any similar instances like this related to this or any other specific opioid pain reliever. I am so sorry to learn this is going on.”
Opana is a drug that started its trend about 5 years ago when the makers of Oxycontin’s reformulated that drug in an attempt to make it harder to abuse. The company who makes Opana- Endo Pharmaceuticals, took similar steps, but Opana contains oxymorphone, an opioid more potent per milligram than Oxycontin, and people have continued to find ways to transform Opana pills into an injectable high.
Experts say the prevalence of Opana abuse varies across the country, but they have stated that just one or two doctors prescribing the drug in large quantities can have a drastic impact on the drugs popularity for abuse.
Kentucky, for instance, saw a spike in Opana overdose deaths in 2011 according to the executive director of the Kentucky Office for Drug Control Policy. But the issue seems resolved since the drug became tamper-resistant. In addition Kentucky closed a number of the infamous ‘pill mills’.
Health and law enforcement officials have fought back against Opana in southeastern Indiana as well, including shutting down pill mills and creating stricter enforcement on prescriptions, and statistics showed that the number of prescriptions had dropped.
But at the same time, heroin use in the area has raised according to Indiana State Police officials.
The recent outbreak has brought the reality of drug abuse to many peoples front door for the first time. That being said, there’s nothing specific about this drug to link it to HIV according to expert opinion. Sharing needles, regardless of the substance, creates the risk of contracting whatever disease the previous user had.
Then again, whenever anyone injects a substance such as Opana, bigger wounds and more bleeding can ensue, which can increase the chance of contamination.
Now, those in health care must bring the message of the dangers of needle sharing to the general public, and state health officials are actively trying to spread the word about the importance of cleaning needles. Here again we see the importance of a harm-reduction approach. Officials are now providing harm-reduction kits to those who use drugs intravenously, and encouraging them to seek treatment.
While the efforts seem well planned, many believe that the outbreak has just begun, and that local clinics should be prepared to test patients in the region worried about contracting HIV through sexual partners, given the nature of the illness. In the near future many bodies will have to come together to help care for those affected by this outbreak, including churches, clinics and counselors. But the public health care system will need to be there to support the community, because some expect the outbreak is likely to impact far too many too soon.
HIV and other infectious diseases are just example one of the countless devastating side-effects of drug abuse. Too many lives are either destroyed or ended because of drugs and alcohol, but there is always a way out for those willing to seek it. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135
Author: Justin Mckibben
America, not to mention a good chunk of the rest of the world has been experiencing a grave increase in drug related issues, including overdose deaths. In America it has been stated that prescription painkiller overdoses have become the leading cause of hospital visits, surpassing even car accidents.
Even though there are strong forces allied together that are pushing for drug policy reform, and harm reduction is expected to make major strides in 2015, some are still predicting even more overdose deaths to come in the next few years.
Straight From Farr’s Law
According to a recent study conducted by Columbia University that was published in the journal Injury Epidemiology, the drug overdose epidemic in the United States will actually peak in 2017, at about 50,000 annual deaths. The study came up with this figure by being the first to apply Farr’s Law on the rise and fall of epidemics to an outbreak that is not from the strict perspective of epidemiologists infectious in origin.
In the United States more than 40,000 people die every year by unintentional drug overdose as of now. Looking at the number over overdose deaths in 1980 that number has multiplied 10 fold! Salima Darakjy, a doctoral student at Columbia University’s Mailman School of Public Health, is an author of the study who stated,
“To some extent, drug use is a social behavior and has the potential to spread like a contagious disease among individuals in a network.”
The Columbia University study does however estimate some good news. According to their figures the drug overdose epidemic may soon be ending, despite the coming spike in fatalities. How did they come up with that if the future is looking to grim? In the mid-1800s a study on smallpox done by pioneering British epidemiologist William Farr, it was discovered that that the rate and duration of the epidemic’s rise was mirrored in its decline.
Things Get Worse Before They Get Better
Using that same formula, the researchers measured the progress of the drug overdose epidemic. Using Farr’s Law, the study found that the drug overdose epidemic should hit its peak at about 50,000 annual deaths in 2017, but then start declining to a non-epidemic state of approximately the same rate it was before the epidemic, putting the body-count at about 6,000 deaths in the year 2035.
According to the researchers at Columbia, the rate of deaths from prescription painkillers, which again are credited for 2/3 of all the overdose related deaths, has already showed signs of decreasing. With stricter regulations being implemented on painkillers to combat the ‘pill mill’ and ‘doctor shopping’ trends, many users have chosen to switch to heroin, which is cheaper and more readily available. Even with taking this substitution effect into account, the experts believe it is still unlikely to alter the course of the epidemic.
However in order for this kind of positive change to take place, public health efforts cannot take a break. Once the epidemic starts to dwindle, the country will still have to continue to take action to reverse the overdose problem.
Director of the Center for Injury Prevention at the Mailman School and professor of Epidemiology, Dr. Guohua Li stated,
“A decline in overdose deaths shouldn’t be used as justification to pull back. That would be wrong. If there is no intervention then the epidemic will last much longer.”
With National Center for Health Statistics data and continued public health resources being used to prevent overdoses, the study concluded that this revolutionary change in statistics was possible. For the year 2014 Congress has committed $20 million in spending on resources to fight the overdose epidemic plaguing the country. It is truly troubling to suspect that we may see a devastating increase in deaths sooner, but hopefully there is some light at the end of that tunnel.
The pandemic of drug overdoses in America is a harsh reality that our country has been faced with in the past few years, and some believe it might only get much worse too soon. While some believe that relief is just a few years away, it is possible for each of us to take the opportunities in front of us. If you are still alive, then you still have a chance. If you or someone you love is struggling with substance abuse or addiction, please call toll-free 1-800-951-6135