pain clinics or pill mills?

[Laker]

http://www.miamiherald.com/467/story...ents_Container

as a crim defense lawyer in the area, many of my clients get busted for possessing these drugs w/o a prescription. most of the time, they drive down from another state, someone makes the score, and they pass them out in the parking lot, where the cops move in.

these places are everywhere down here. what do you think about them? are the docs scumbags or providing a needed service?

[DCJenn]

Laker-

On the treatment side, I can tell you that they are the bane of my existence. Pain meds and psych meds should not be dispensed by emergency rooms or primary medical clinics- but until our craptastic health care situation gets sorted out...they are what they are.

If people with legitimate health care needs had access to the kinds of specialists not typically covered by Medicaid (or people had access to health care, period) I think this would be one of those issues that would ultimately disappear.

We have people dealing xanax in the methadone clinic, selling oxycontin in the parking lot, etc. It's a huge problem.

Jenn

[SuzySunshine]

wrong thread

[GrayMatterWife]

Laker! Yea! I haven't seen you around in a while!

On your thread...I think it's unfortunate all the way around. People doing time for personal possession, cop time having to be utilized for this, exploitation of addiction, all the attendant problems with addiction, overdosing, crime, etc....

I thought the characterization of the mess as "pharmaceutically diverted drugs" was pretty funny, though.

[diggitydot]

A pain clinic in WA was recently raided and shut down. Here's what's happening to the patients and local docs/hospitals trying to deal with the influx of outrageously medicated patients:



http://www.columbian.com/article/200...6/-1/NEWSLOCAL

Hundreds of former Payette Clinic patients, riddled with chronic pain or a severe addiction to painkillers, have swarmed Clark County hospitals and pain clinics in recent weeks.

Many of them are being turned away or placed on months-long waiting lists. Even those being treated in emergency rooms or by primary care doctors say they are being told to fend for themselves because of doctors' fear of medical liability.

Payette Clinic was the subject of a Washington Department of Health investigation last month that found nurse practitioner and clinic co-owner Kelly M. Bell was prescribing "extremely high doses of opioids." As part of the investigation, Bell and her staff had to surrender their credentials to prescribe controlled substances.

The fallout has been overwhelming for physicians and devastating for some patients.

"As soon as we say 'Payette Clinic,' no one wants to help us," said Larae Corzine, whose husband, Steve, was a Payette patient for several years. He was treated for reflex sympathetic dystrophy, a chronic neurological syndrome characterized by severe burning pain. "Now, he can't even get out of bed. He wants to live. He's only 40 years old."

Southwest Washington Medical Center officials estimate about 800 patients no longer receiving prescriptions from Payette are beginning to inundate hospitals, urgent care centers and treatment centers. Of the 800, 120 patients have already been referred to Southwest Washington Medical Center's Interventional Pain Clinic.

"They're getting 10 times what they're used to," said Dr. Michael Bernstein, director of Southwest Washington Medical Center's Department of Behavioral Health. "They've tried to increase time and availability of practitioners. They've done everything they can to tweak capacity."

Some will just have to wait. "It's going to be months to get through 120 patients," said Christine Gauf, the Interventional Pain Clinic's director. "We're asking those patients to be patient. We only have so many providers, and there are only so many hours in the day."

Attempts to reach an official of the Payette Clinic were unsuccessful.

Another dilemma for physicians? Deciding how to best treat these patients, many of whom are addicted to painkillers and still suffer enough chronic pain to warrant a narcotic.

Physicians aren't inclined to continue prescribing painkillers, especially at high doses.

"It's pretty clear that no one felt comfortable continuing patients on these narcotics," Bernstein said. "They all thought it would be malpractice to give them a prescription."

Bernstein is spearheading a committee of physicians and treatment specialists countywide to assess how to handle Payette patients.

The committee has circulated memos to local family care physicians, treatment centers, pain clinics and hospital officials, urging providers to taper patients off medications or detox them. Still, each patient is being handled on a case-by-case basis, physicians say.

Severe withdrawals

Some patients are turning up at local hospitals' emergency departments with severe withdrawal symptoms.

Kim Manning said her sister, who prefers to not be identified, was a Payette patient for chronic migraines. For the past several years, Manning's sister's doses gradually increased to 750 mg of morphine, which doctors say is 10 times the usual dose of morphine for a pain patient.

Following the Payette's suspension of prescribing opioids, Manning's sister began suffering the withdrawal symptoms of vomiting and diarrhea. When her organs started shutting down, she was admitted to Southwest Washington's intensive care unit and put on a respirator, Manning said.

She wasn't given any opioid at the hospital out of fear it would feed an addiction, Manning said.

"It's just inhumane what she's going through right now," Manning said.

Doctors placed her on withdrawal medication and she appears to be recovering, Manning said.

Another Payette patient still battling extreme pain and withdrawal is Steve Corzine, who is unable to work because of the disorder.

"The pain is 10 times worse than it's ever been," Larae Corzine said. "He's vomiting and shaking. I'm surprised he hasn't gone into seizures."

Larae Corzine said she has called several doctors in town for her husband. Steve was seen by a doctor in Battle Ground. But when the doctor told him it would take months to get into a pain clinic, Steve left.

Eventually, Steve was seen at Legacy Emanuel's pain clinic in Portland and placed on a much smaller dose of Oxycontin, which is relieving some pain.

Since Legacy could only offer a one-time consultation, Larae said her husband doesn't have a primary care physician to treat him when the painkillers run out.

Painkiller alternatives

Physicians say they are aiming to treat former Payette patients with alternatives to prescription opioids. Among the alternatives used by Dr. John Luckwitz, a pain specialist at the Interventional Pain Clinic, are physical therapy, spinal injections or surgery.

With the former Payette patients, Luckwitz said he plans to evaluate the extent of each patient's pain to decide whether to continue prescription opioids at lower doses.

"The ones I've personally seen are open to other options," he said.

Some patients are clearly addicts, while others are people with legitimate pain problems who need ongoing painkiller medication, Luckwitz said.

The memo circulating among physicians recommends not refilling painkiller prescriptions if a patient exhibits signs of addiction, but to detox those patients in a treatment facility instead. Another recommendation in the memo is to prescribe Suboxone, a medicine that treats opioid withdrawal.

Lastly, if patients must continue taking narcotics, the memo urges physicians to lower the doses gradually. "For those patients who it is felt should be on opioid … a reduction of 5 percent a day may be done or even much slower," the memo said. "In extremely high doses of opioid, this may not be practical, and a more aggressive reduction may be necessary."

In light of the Payette Clinic fallout, Bernstein said he hopes the current dilemma will send a message to the greater medical and treatment community.

"There aren't many resources in Clark County or Multnomah County to manage chronic pain or chemical dependency," Bernstein said. "We're getting a harsh reminder of that."

[DCJenn]

Great....

Because we have so much room for detoxing pain med patients...

Jenn