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CMC physician supports new database designed to combat epidemic of painkiller abuse
By Jon Tatting
jon.tatting@ecm-inc.com
A doctor prescribes a long-lasting narcotic, such as Vicodin, Percocet or OxyContin, to a patient complaining of chronic pain.
The patient, with a smaller dosage, faces an empty pill bottle in no time and is denied refills. A search then begins and evolves into a “shopping spree” at area emergency rooms and same day/urgent care clinics—if not the streets for other opiates, such as heroin—to get desired painkillers.
This scenario, a common reality nationally and locally, is the journey of painkiller addicts who go “doctor shopping” to avoid setting off red flags from a particular physician or pharmacy. They will travel miles, making several “shopping” attempts a day to satisfy their drug habit.![]()
However, a new statewide database aims to help and keep these narcotic seekers in check by documenting their every stop—even across health provider lines—so doctors can identify trends, problems and help addicts to recovery. Pharmacies are required to collect patient and doctor information on every prescription filled in order to help control what’s become a national epidemic of painkiller abuse.
 Dr. Dale Berry, (pictured on the left) medical director of substance abuse services and family medicine physician at Cambridge Medical Center, is approaching 32 years at the Allina facility where he assists many patients with treatment programs.
“Traveling patients are clearly addicts, drug seeking and need help,” said Dr. Berry via phone interview last week. “The database is a tremendous tool to help opiate addicts get help. The pressure is on ER doctors, same day/urgent care and those accessed to get narcotics. They (addicts) don’t go through their family doctor.”
When the statewide database launches in March, local pharmacists and doctors will be able to see if patients are accessing an overload of prescriptions for the same narcotics from different providers. This will mark a first in Minnesota, which is the 34th state to monitor prescriptions for controlled substances. Thanks to a $400,000 federal grant, the registry is anticipated to track over one million prescriptions a year.
“This is a good policy,” said Dr. Berry of the new registry. “It protects patients from hardship and assists doctors with making decisions based on accurate and up-to-date information.”
Infringement on privacy?
The database is also considered controversial.
It allows doctors from multiple facilities to check a person’s prescription record, thus a privacy issue held in high regard under the Health Information Privacy Act (HIPA) of 1999. Others say it may prevent some doctors from prescribing needed painkillers out of fear of being legally investigated or possibly losing their license.
You are taking away some privacy interest of patients, Dr. Berry said. For instance, he noted, when you have a tooth removed, it should be between you and your dentist. A person in a mental health unit, meanwhile, should only be known to that facility.
Addressing Allina’s policy on patient privacy, Dr. Berry noted an employee cannot open a record, or “break the glass,” that is private to the facility. If done unjustifiably, the employee will be fired. “It’s a no tolerance policy. We take patient privacy seriously,” he said.
On the new database, he said, “The point is for ER staff to identify patients with a problem. Doctors will examine the ‘problem’ and can call (patients) on it.” Before, staff such as emergency doctors could neither call other providers—based on a hunch—to see if a patient had an issue with doctor shopping nor keep a log of patients suspected of drug seeking.
“We’re letting some privacy go in order to protect all of us,” said Dr. Berry. “The ultimate goal and hope is to help that patient and stop drug seeking.
“All we can do is to say, ‘this is a problem,’ and document their response,” he added, noting addiction can be difficult to diagnose.
‘The Perfect Storm’
When Dr. Berry first started in medicine, he noted doctors didn’t prescribe many long-lasting narcotics.
In the 1980s and early ‘90s, however, the medical community found that malignant pain (cancer) and nonmalignant chronic pain (physical, emotional and financial disability) were not treated aggressively enough.
With regard to cancer patients in need of appropriate relief, anesthesiologists once led the control on pain. This was strange and bewildering since they lacked a patient’s history, said Dr. Berry.
Since the late 1990s, he continued, “We have been instructed by pain people to provide better pain relief for patients.” In fact, the Minnesota Board of Medical Examiners has said if doctors don’t provide this relief, their license could be in jeopardy.
Groups such as residency programs and medical schools have also found that it’s “extremely rare” for people to become addicted to narcotics, said Dr. Berry, noting the groups’ response to pain research.
“The good news is we’ve begun to treat people with malignancy pain more aggressively,” he explained, noting hospice patients, for example, have been receiving better comfort.
The bad news? Others wanted relief, too. They insisted on and received chronic pain medication, Dr. Berry said.
In addition, doctors believed, based on communications with the Minnesota Board of Medical Examiners, that their license could be in jeopardy for not prescribing narcotics for pain. “It was a threat, a push,” he noted.
That said, Dr. Berry explained these factors and more created a “perfect storm”: patient demand, supported by more prescriptions by doctors; the threat to treat pain by the state board of examiners and boards across the country; the science component, indicating the slight chance people can become addicted; and the biology of it.
These narcotics are “addictive and tolerance producing,” said Dr. Berry. “It’s not a long trip before people take enough to not hit withdrawal. It’s an epidemic at this point.”
It should be noted that painkillers have been proved to be quite safe, effective and helpful for relief when taken responsibly and as directed by one’s regular physician.
While the state estimates around 117,000 Minnesota adults abuse prescription drugs every year, Dr. Berry said that figure is likely low. Citing evidence, he noted 75 percent of people prescribed the stimulant Adderall admitted to not taking it as directed; taking the pills based on emotional need; quickly running out due to increased use; and using street drugs to increase the euphoric effect.
Addressing another issue, perhaps even the bigger picture of the matter: “We have to be aware of the social problems of an addict. Addiction is not just an annoyance; it’s a very bad disease and can ruin a life,” added Dr. Berry, noting the disease can and does surface at a very young age.
PRESCRIPTION DRUG ABUSE
Although most people take prescription medications responsibly, there has been an increase in the nonmedical use of prescription drugs in the United States, according to the Hazelden Foundation, based in Center City, Minn.
Medications that are commonly abused include opioids, or opiates, which are often prescribed to treat pain; central nervous system (CNS) depressants, used to treat anxiety and sleep disorders; and stimulants, prescribed to treat the sleep disorder narcolepsy and attention-deficit hyperactivity disorder (ADHD).
Hazelden explains:
• Opioids/opiates are commonly prescribed because of their effective pain-relieving results. These prescription narcotics include morphine (Kadian, Avinza), codeine, oxycodone (OxyContin, Percodan, Percocet) and related drugs such as Vicodin. While morphine is often used before and after surgical procedures to alleviate severe pain, codeine is mainly prescribed for mild pain.
• CNS depressants, also referred to as sedatives and tranquilizers, are substances that can slow normal brain function. Common medications include Mebaral and Nembutal, used to treat anxiety, tension and sleep disorders. Medications as Valium, Librium and Xanax are prescribed to treat anxiety, acute stress reactions and panic attacks.
• Stimulants, including Adderall, Dexedrine, Ritalin and Concerta, increase alertness, attention and energy, as well as elevate blood pressure and increase heart rate and respiration. Though historically used to treat such ailments as asthma and obesity, their potential for abuse and addiction became apparent. Stimulants are now prescribed for only a few health conditions, such as narcolepsy, ADHD and depression in some cases.
— The Hazelden Foundation, a non-profit organization, offers assessment and primary residential addiction treatment for adults and youth, including extended care and intermediate care, as well as outpatient treatment, aftercare services and a family program. For more information, call 1-800-257-7810 or visit www.hazelden.org
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