The pain of abuse

Illegal use of prescription drugs becoming target of more investigations

It's not often that we hear of GRAMNET knocking down someone's door to raid his or her stash of prescription medicine. Craig Police Chief Walt Vanatta said his department rarely becomes involved in cases of prescription drug abuse. But in light of recent celebrity confessions, prescription drug addiction is gaining more coverage, although those who work in the trenches say it isn't a new problem.

The Colorado Prescription Drug Abuse Task Force was formed in 1984 after Colorado ranked in the top 15 states for per capita consumption of nine abused prescription drugs. Through the task force's efforts those numbers have declined sharply.

The task force publishes a book of common scams addicts use to get prescriptions for their favorite narcotics. They use sophisticated ploys, tap doctors' phones and even enlist amputees and paraplegics as actors in their quest for drugs. Hospitals and clinics have found themselves the middlemen in this licit drug trade where prescription medications bring big dollars on the narcotics market. Trafficking aside, independent users find their way into clinics or emergency rooms to feign symptoms and procure narcotics like Percocet, Vicodin and Demerol.

In a 2001 report, the Colorado Prescription Drug Abuse Task Force stated, "According to data collected by Congress, the National Institute on Drug Abuse and the Drug Enforcement Administration, prescription drug abuse is the cause of more injuries and deaths than all illegal drugs combined."

The American Medical Association says it is our nation's "hidden" drug abuse problem.

"We see the exact same thing in our community," said Dave Higgins, a veteran nurse in The Memorial Hospital's emergency room.

During a typical encounter, a patient enters the ER complaining of pain. It's almost always a migraine, dental pain or back pain, and the narcotic they most often request, by name, is Percocet, according to Doctor Larry Kipe, who has a private practice at Moffat Family Clinic but works in the ER on a rotating basis.

Kipe said he's familiar with the ruse, but there's no way to prove someone isn't in pain.

"It's hard to see people in pain," Kipe said. "I give people the benefit of the doubt unless they come in over and over giving the same story."

On the other hand, some patients obviously are shopping around for narcotics.

"How many times can a guy's medicine fall in the toilet?" Kipe asks.

Addicts hoping to get prescriptions often claim allergies to medications except the one they like to get high on. These savvy patients know exactly which drugs they like and can list the dosage levels.

Their scam becomes more apparent when they fill only the narcotic that was prescribed, not the accompanying antibiotics or other pharmaceuticals, Kipe said. Also, when they fail to line up treatment for the supposed ailment, and instead become chronic ER patients, the gig is up.

In these cases, Kipe can prescribe non-narcotic drugs that manage the pain but don't get abused.

"I can send a guy out of here with one of those medications and know I've taken care of his pain without narcotics," Kipe said.

Some patients don't give up quite so easily.

Higgins said belligerent, drug-seeking patients literally scream at him, refusing to leave until they get their fix.

"I've had people demand their Demerol shot or they won't leave," Higgins said. "And they throw a fit."

It's a difficult spot for the ER staff to be in because they treat everyone. A doctor with a private practice can "fire" a patient or set up an agreement to wean the patient off of the narcotics.

But in the ER, "we have to see everybody," Higgins said.

Eventually, private practitioners do catch on, creating a phenomenon known as "doctor-shopping," when addicts move from doctor to doctor as they are refused treatment or given ultimatums by doctors who've figured them out.

Some of these patients are referred to pain specialists after doctors tell them it's obvious their problem isn't going away because they just keep coming back for more pills. Through research, the specialists may find a drug abuser has seen many doctors throughout the valley, Higgins said.

"They may have four or five doctors prescribing the same medicine," Higgins said.

In fact, Kipe said he received a call from a pharmacist last week who advised him that a patient Kipe had prescribed medicine to had procured a similar prescription from a different doctor.

"Do you still want to dispense it?" the pharmacist wanted to know. Kipe told him no.

Kipe downplays the extent of the problem in his own practice, saying that he might see 100 patients in a week and only one of them presents a possible case of prescription medicine addiction. But if one estimates that other doctors see the same typical numbers, Kipe admits it is a "big problem."

Emergency room staff encounters it multiple times a week. It easily averages out to one case a day, Higgins said.

Part of the difficulty treating these suspicious patients is that it goes against his training, Higgins said.

"You're taught to treat their pain. It's the patient's pain. Treat what they perceive it to be," Higgins said. He said nurses are instructed not to pass judgement about the severity or the cause of the pain. But he admits it's difficult when the pattern of abuse becomes obvious.

"With known patients you've seen over and over and over, you feel like you are the drug pusher, literally," Higgins said as he made the motion of pushing a syringe.

It's very rare for a patient to come to the ER and say, "I'm having withdrawals. I need some help."

Even if they did, Higgins said the problem is that there's nowhere for them to dry out. They can be detoxed for a period of time, but as far as a long-term treatment program, there just isn't one in Craig.

But occasionally, patients find treatment in other places. Kipe said he personally knows of success stories. He's received letters from therapists telling him of the indiscretions of former patients.

"People do some amazing things," Kipe said, remembering a letter about a woman who knew he would not re-prescribe a drug to her within 30 days. She had her calendar marked, and she'd show up regularly. Unknown to Kipe, the woman would consume a whole bottle of drugs at one sitting, along with some alcohol.

Both Higgins and Kipe insist the narcotics used to treat pain present no addiction problems if used responsibly.

"People who have bona fide pain rarely ever get addicted," Kipe said. They may develop a physical dependence, but that is far from the situation where addicts gulp pills with other drugs, lie to multiple doctors -- often at the same time -- and shop around in a relentless search for the legal drugs they seek.

"There is a real difference between using a drug to get high rather than treat pain," Kipe said.

Jeremy Browning can be reached at 824-7031 or jbrowning@craigdailypress.com

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