My local community is currently undergoing a massive addiction crisis.
A large pain management clinic was recently shut down because the physician overseeing it lost his license. It was suspended last week on an emergency basis because an investigation revealed that many of the patients there were being over-treated, undoubtedly because of an addiction they had developed to the narcotic pain medications. The physician himself is under investigation for dispensing excessive quantities of controlled substances out of his office, and he was felt by the investigating body to be a danger to the community. With his center closed,there are four or five hundred poorly-managed chronic pain patients in this community who have suddenly lost access to their source of drugs. Some of these people surely have chronic pain issues that need to be addressed, while many probably have primary addiction problems, but either way, all are physically dependent on massive doses of methadone, Percocets, and Oxycontins. Without these medications, or any managing therapy to replace them, these four or five hundred people will be horribly sick, in great pain, and possibly driven to unacceptable behavior (theft, etc.) in order to find new sources of the drug they feel they need.
Physicians in the area are not excited about taking on new patients with poorly maintained or spotty medical records and poorly managed, poorly documented pain issues, especially since all these patients need immediate refills of their massive amounts of narcotics. The addiction doctors in the area, the few of them that there are, are not really qualified to evaluate these patients for the true status of their pain condition, and so have no real way to separate the primary pain patients from the primarily addicted patients. Most addiction-based physicians are at or near their 100 patient Suboxone limit in any case, and do not routinely prescribe other narcotics.
We also can’t forget about the ERs, where physicians are also wondering how they will handle this massive crisis. ER doctors will ultimately become the last resort for many of these patients who cannot get their prescriptions filled in a more controlled manner. The ER will be flooded with people with a multitude of pain complaints and withdrawal symptoms, trying desperately to get their narcotics filled. I cannot begin to imagine how much time and money will be wasted doing unnecessary testing for complaints of abdominal pain, back pain, and headaches — not to mention the delay in attending to others who will be competing for ER time with many of these patients.
This is not the fault of these patients — it is primarily the fault of the physician who so badly mismanaged their care, and his staff who were clearly not trained to recognize or deal with the addiction problems that so often attend pain management. (I very much doubt that he knew that he might want to be on the lookout for addiction problems.) Due to his recklessness and carelessness, the medical systems of this community are very shortly going to be overloaded with patients who desperately need to be managed and are extremely difficult to correctly diagnose.
A harm reduction model would suggest that somebody just needs to open up an office and provide all these people with the narcotics they want to keep them from flooding and incapacitating the rest of the system. That is essentially the role that the suspended pain management center was playing, and while it was logistically effective, no plan like that will ever be sustainable. Not to mention, of course, that it is a gross violation of the goals and ethics of medicine.
I don’t know how this situation will resolve. I will do my best to take on excess patients when I can be sure that their problems are primarily addiction-related, and I’m going to make an effort to educate my fellow medical practitioners about this issue. If nothing else, I hope this can serve as a warning of what can happen even when we do the right thing by closing down a poorly-run pain management center. Maybe soon we will be able to move forward to find a more sustainable solution.