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USA TODAY
Crackdown on painkiller epidemic hurts legitimate patients
By Cris Barrish, The (Wilmington, Del.) News Journal Updated 4h 20m ago
Comments 22
WILMINGTON, Del. When Antoinette Tortorella's doctor took her off narcotics in January because she would not agree to a spinal implant, she decided to get a new doctor
Antoinette Tortorella, 45, of Newark, Del., suffers from the degenerative effects of scoliosis. It has been difficult for Tortorella to find a doctor who will treat her with the painkiller oxycodone.
Antoinette Tortorella, 45, of Newark, Del., suffers from the degenerative effects of scoliosis. It has been difficult for Tortorella to find a doctor who will treat her with the painkiller oxycodone.
Finding someone else who would treat her with the painkiller oxycodone was harder than Tortorella anticipated, though. Calls to several pain physicians were initially fruitless. Either they were not taking new patients or did not return her calls.
Tortorella, 45, suffers from degenerative scoliosis curvature of the spine and can only walk slowly, hunched over and wracked with agony. As the days went on without a new doctor, she began to worry she'd run out of the pills and the Fentanyl patches that make her pain bearable. She also faced the prospect of severe withdrawal from the addictive medication.
Tortorella, who until her pain got so bad about three years ago had worked in banking and sales, finally found a new doctor. The doctor reduced her medication, however.
Tortorella is a casualty of the painkiller epidemic that has engulfed Delaware and much of America. With so many patients selling or misusing their drugs, pain medications now have a stigma, leaving many doctors unwiling to take on legitimate pain patients. Others simply don't have the expertise.
The state's recent crackdown on doctors who irresponsibly prescribe narcotics has compounded the problem for people with severe, debilitating pain. When doctors get stripped of their licenses, legitimate patients can have a difficult time getting someone else to treat them, often leading to desperate trips to emergency rooms.
Dr. Brent Passarello, an emergency room physician at Christiana Hospital, said he's treated some patients of doctors recently suspended from prescribing painkillers and anticipates more in the same predicament.
"There's been a number of patients who are struggling," Passarello said. "It's been a struggle for us because of the volume of patients we're being asked to manage."
Delaware regulatory and medical officials say they are aware of the dilemma and encourage patients to work with their insurers to get the appropriate care.
James L. Collins, director of the state Division of Professional Regulation that oversees the medical disciplinary board, said his agency recently started alerting physicians and hospitals "when a doctor was getting suspended so they would prepare for the effects of that suspension."
Doctors, however, often have thousands of patients and many don't want to take on more. Sheila Grant, a registered nurse who is president of the Hospice and Palliative Care Network of Delaware, said doctors are concerned by media coverage of prescription drug abuse and by tough action of late by Collins' office.
Fears by physicians -- especially family doctors who can write narcotics prescriptions but often lack the experience of managing chronic pain patients -- are understandable, Grant said.
"Treating chronic pain is not something they get educated on, so doctors are very reluctant to prescribe," Grant said. "They are afraid of getting a knock at the door from somebody with the government who wants to look at their charts."
Tortorella is upset with doctors who won't treat people like her and with those who abuse the drugs that help her cope.
"I would give anything to be healthy and able to work, and people who are in perfect health are using these drugs illegally and casting suspicion on people like me," she said while fighting back tears at her elderly mother's home near Newark and laying face down the couch, the position that hurts the least.
"I'm legally disabled. I'm not pretending I'm hurt."
'Too many headaches' for doctors
John O'Hearn, a retired hotel executive who lives in Milford and suffers from a painful neuromusuclar disease, can relate to Tortorella's plight.
Homebound except for visits to the doctor, the 65-year-old O'Hearn has taken various narcotics prescribed by a succession of doctors over the last decade.
But in December, state officials took emergency action to yank the license of his doctor to prescribe controlled drugs. O'Hearn had to scramble to avoid a lapse in his treatment.
He called several pain management practices in Kent and Sussex counties, only to find it would take months to get an appointment. He asked his rheumatologist to give him a painkiller prescription, only to get rebuffed.
"He told me, 'I don't write narcotic prescriptions anymore. There's too many headaches involved,' " O'Hearn said.
Getting desperate as his supply dwindled, he went to an emergency room, bringing his list of prescriptions for the last year, along with 30 pages of medical records, he said. The doctor, however, "didn't want to hear" of his plight, and would only give him drugs to to help him through withdrawal, O'Hearn said, so he left without getting any medication.
He next called Delaware Gov. Jack Markell's office, where an aide who put him in touch with a social services official who found a doctor in New Castle County. Though the monthly trek is more than 60 miles from his home, O'Hearn is grateful that a neighbor drives him and the doctor agreed to treat him. For now, he's getting the medication he needs.
The fact that he practically had to beg for treatment angers O'Hearn.
"It's insulting to someone who is legitimately disabled," O'Hearn said. "I don't think it's fair to lump disabled people in with the mutts who abuse drugs. I get no better treatment than the junkie who is going into a doctor's office to get his pills."
He also has a harsh message for the doctors who shy away from taking pain patients like himself.
"They shouldn't be doctors," he said, "if they can't differentiate."
Proper training
Physicians must get the proper training so they can decide which patients truly need narcotics and those who divert them to illegal uses, said Dr. John Goodill, director of Pain Management and Palliative Care at Christiana Care.
"If physicians aren't astute enough to screen and assess them for the risk of abusing or diverting them, they are going to give those medications to the wrong population," Goodill said, adding that studies show that the vast majority of patients do not abuse pain medications.
Doctors often shy away from taking on pain patients, Goodill said, because some have a host of physical or possibly mental conditions that make developing and monitoring a treatment regimen a complex, time-consuming task. "They are very difficult to take care of and have multiple overlapping problems," Goodill said.
Collins stressed that the state would do everything in its power to protect the public from incompetent and crooked doctors, and said the medical community needs to step up as well.
"Whenever a doctor loses their ability to write for controlled substances, there are collateral consequences. But there are also dire consequences for inappropriate prescribing and ignoring the warning signs," Collins said.
"We're certainly not trying to dissuade people from prescribing controlled substances in treating chronic pain. But we're paying close attention to those folks who haven't had the training, who don't do the patient assessments, and aren't paying attention to the signs of abuse."
For Tortorella, confined mostly to her mother's home in Brookside, she's grateful to have found someone to treat her, but is hoping the dosage gets increased so she can feel well enough to do some volunteer work for the Little Sisters of the Poor.
She'd love to work again, but can't bear to be on her feet or even at a desk.
Only the narcotics, she said, offer relief.
"I've never abused the pills," she said, stressing that she never failed her monthly urine screen. "I don't drink alcohol. I don't smoke. I just need to have my medication."
For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to [email protected]. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.
Crackdown on painkiller epidemic hurts legitimate patients
By Cris Barrish, The (Wilmington, Del.) News Journal Updated 4h 20m ago
Comments 22
WILMINGTON, Del. When Antoinette Tortorella's doctor took her off narcotics in January because she would not agree to a spinal implant, she decided to get a new doctor
Antoinette Tortorella, 45, of Newark, Del., suffers from the degenerative effects of scoliosis. It has been difficult for Tortorella to find a doctor who will treat her with the painkiller oxycodone.
Antoinette Tortorella, 45, of Newark, Del., suffers from the degenerative effects of scoliosis. It has been difficult for Tortorella to find a doctor who will treat her with the painkiller oxycodone.
Finding someone else who would treat her with the painkiller oxycodone was harder than Tortorella anticipated, though. Calls to several pain physicians were initially fruitless. Either they were not taking new patients or did not return her calls.
Tortorella, 45, suffers from degenerative scoliosis curvature of the spine and can only walk slowly, hunched over and wracked with agony. As the days went on without a new doctor, she began to worry she'd run out of the pills and the Fentanyl patches that make her pain bearable. She also faced the prospect of severe withdrawal from the addictive medication.
Tortorella, who until her pain got so bad about three years ago had worked in banking and sales, finally found a new doctor. The doctor reduced her medication, however.
Tortorella is a casualty of the painkiller epidemic that has engulfed Delaware and much of America. With so many patients selling or misusing their drugs, pain medications now have a stigma, leaving many doctors unwiling to take on legitimate pain patients. Others simply don't have the expertise.
The state's recent crackdown on doctors who irresponsibly prescribe narcotics has compounded the problem for people with severe, debilitating pain. When doctors get stripped of their licenses, legitimate patients can have a difficult time getting someone else to treat them, often leading to desperate trips to emergency rooms.
Dr. Brent Passarello, an emergency room physician at Christiana Hospital, said he's treated some patients of doctors recently suspended from prescribing painkillers and anticipates more in the same predicament.
"There's been a number of patients who are struggling," Passarello said. "It's been a struggle for us because of the volume of patients we're being asked to manage."
Delaware regulatory and medical officials say they are aware of the dilemma and encourage patients to work with their insurers to get the appropriate care.
James L. Collins, director of the state Division of Professional Regulation that oversees the medical disciplinary board, said his agency recently started alerting physicians and hospitals "when a doctor was getting suspended so they would prepare for the effects of that suspension."
Doctors, however, often have thousands of patients and many don't want to take on more. Sheila Grant, a registered nurse who is president of the Hospice and Palliative Care Network of Delaware, said doctors are concerned by media coverage of prescription drug abuse and by tough action of late by Collins' office.
Fears by physicians -- especially family doctors who can write narcotics prescriptions but often lack the experience of managing chronic pain patients -- are understandable, Grant said.
"Treating chronic pain is not something they get educated on, so doctors are very reluctant to prescribe," Grant said. "They are afraid of getting a knock at the door from somebody with the government who wants to look at their charts."
Tortorella is upset with doctors who won't treat people like her and with those who abuse the drugs that help her cope.
"I would give anything to be healthy and able to work, and people who are in perfect health are using these drugs illegally and casting suspicion on people like me," she said while fighting back tears at her elderly mother's home near Newark and laying face down the couch, the position that hurts the least.
"I'm legally disabled. I'm not pretending I'm hurt."
'Too many headaches' for doctors
John O'Hearn, a retired hotel executive who lives in Milford and suffers from a painful neuromusuclar disease, can relate to Tortorella's plight.
Homebound except for visits to the doctor, the 65-year-old O'Hearn has taken various narcotics prescribed by a succession of doctors over the last decade.
But in December, state officials took emergency action to yank the license of his doctor to prescribe controlled drugs. O'Hearn had to scramble to avoid a lapse in his treatment.
He called several pain management practices in Kent and Sussex counties, only to find it would take months to get an appointment. He asked his rheumatologist to give him a painkiller prescription, only to get rebuffed.
"He told me, 'I don't write narcotic prescriptions anymore. There's too many headaches involved,' " O'Hearn said.
Getting desperate as his supply dwindled, he went to an emergency room, bringing his list of prescriptions for the last year, along with 30 pages of medical records, he said. The doctor, however, "didn't want to hear" of his plight, and would only give him drugs to to help him through withdrawal, O'Hearn said, so he left without getting any medication.
He next called Delaware Gov. Jack Markell's office, where an aide who put him in touch with a social services official who found a doctor in New Castle County. Though the monthly trek is more than 60 miles from his home, O'Hearn is grateful that a neighbor drives him and the doctor agreed to treat him. For now, he's getting the medication he needs.
The fact that he practically had to beg for treatment angers O'Hearn.
"It's insulting to someone who is legitimately disabled," O'Hearn said. "I don't think it's fair to lump disabled people in with the mutts who abuse drugs. I get no better treatment than the junkie who is going into a doctor's office to get his pills."
He also has a harsh message for the doctors who shy away from taking pain patients like himself.
"They shouldn't be doctors," he said, "if they can't differentiate."
Proper training
Physicians must get the proper training so they can decide which patients truly need narcotics and those who divert them to illegal uses, said Dr. John Goodill, director of Pain Management and Palliative Care at Christiana Care.
"If physicians aren't astute enough to screen and assess them for the risk of abusing or diverting them, they are going to give those medications to the wrong population," Goodill said, adding that studies show that the vast majority of patients do not abuse pain medications.
Doctors often shy away from taking on pain patients, Goodill said, because some have a host of physical or possibly mental conditions that make developing and monitoring a treatment regimen a complex, time-consuming task. "They are very difficult to take care of and have multiple overlapping problems," Goodill said.
Collins stressed that the state would do everything in its power to protect the public from incompetent and crooked doctors, and said the medical community needs to step up as well.
"Whenever a doctor loses their ability to write for controlled substances, there are collateral consequences. But there are also dire consequences for inappropriate prescribing and ignoring the warning signs," Collins said.
"We're certainly not trying to dissuade people from prescribing controlled substances in treating chronic pain. But we're paying close attention to those folks who haven't had the training, who don't do the patient assessments, and aren't paying attention to the signs of abuse."
For Tortorella, confined mostly to her mother's home in Brookside, she's grateful to have found someone to treat her, but is hoping the dosage gets increased so she can feel well enough to do some volunteer work for the Little Sisters of the Poor.
She'd love to work again, but can't bear to be on her feet or even at a desk.
Only the narcotics, she said, offer relief.
"I've never abused the pills," she said, stressing that she never failed her monthly urine screen. "I don't drink alcohol. I don't smoke. I just need to have my medication."
For more information about reprints & permissions, visit our FAQ's. To report corrections and clarifications, contact Standards Editor Brent Jones. For publication consideration in the newspaper, send comments to [email protected]. Include name, phone number, city and state for verification. To view our corrections, go to corrections.usatoday.com.
