CANCER, PATIENT, PAIN, SUICIDE AND DEA POLICY:WHEN AN ONCOLOGIST FEARS TREATING “CANCER”

FROM THE LAWHERN FILES

__THE STORY HOW ONE ONCOLOGIST SPECIALIST TRIED TO RESTORE DIGNITY TO THE LIFE OF ONE HUMAN BEING AND LOST HIS LICENSE TO PRACTICE MEDICINE __

REPORTED BY

NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, JOSEPH SOLVO ESQ., REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, SHELLEY HIGHTOWER, BS., PHARMD.,  LEROY BAYLOR,  ADRIENNE EDMUNDSON, WALTER L. SMITH BS., LEROY BAYLOR, BS., MS., MS., BRAHM FISHER ESQ., MICHELE ALEXANDER, CUDJOE WILDING BS, DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

BY

AN ONCOLOGIST WHO LIVES IN FEAR

Dr. Lawhern:

I have read some of your blogs.  I completely agree with many of the things you stated as they apply to my particular case where I lost my license.  The reluctance of so called “pain physicians” to care for patients who are on high doses of opioids and/or who show signs of “aberrant behavior” leaves patients suffering from pain and addiction in a precarious position and risk for suicide. It also leaves poor physicians like me (an Oncologist)  who try to provide appropriate care for patients in real pain and addiction in a terrible position.

The patient I was caring for middle aged African American woman, single parent, without adequate insurance unfortunately committed suicide by overdosing on the opioid drugs I was supplying her. I feel due to the constant fighting she experienced with the medical system including pharmacies, doctors, hospitals. I was trying as best I could to find a doctor with appropriate experience  to care for her, but they are an extreme rarity.

THE PAIN OF INDIFFERENCE

In her case, she was probably asking  high doses i.e. double the dose she was using and selling some of the drugs to pay for the drugs she was using as her insurance refused to pay for her opioids. She was also doing early refills.  She was seen by three pain specialists who observed aberrant behavior and either just “dropped her” or instituted or suggested rapid tapers leaving me -a hapless oncologist – with the task of wrestling with her pain control and addiction.

Two of these pain specialists all verbalized the fear of the DEA as the reason for tapering to “safe” levels – which I felt was inadequate to control her pain.  A fourth pain specialist wanted to give her methadone without any other referral to addiction or psychologist and also proposed a rapid taper of her opioids which the patient did not want to accept. No pain specialist she saw would say “ok you have addiction but you also have real pain, so I as a pain specialist will take your case on knowing its high risk and work with an addiction specialist and perhaps a psychologist and we will work together to when appropriate try to taper you slowly and appropriately and improve your situation.  

It seems in my opinion, the medical and legal world divides patients into two categories:  

(1) Patients who show patterns of addiction: Providers are taught that these patients should be “dropped” because health care providers will be sanctioned by the DEA and state for “inappropriate prescribing of controlled substances”  under the controlled substance act and lose their license  These patients are at highest risk of overdose (according to the CDC guidelines in 2016) and hence increase the fear of prescribing to such patients.   

(2) Patients who have a legitimate  need meds for pain control (with or without  dependence). These patients can continue to take their opioids safely as long as they are low doses continued to be prescribed opioids. 

“THE WAR ON DRUGS IN A WAR ON DOCTORS AND THEIR PATIENTS AND IT MUST STOP”

 I don’t know the numbers, but patients who have a combination of one and two above i.e.with legitimate pain and who show signs of aberrant behavior are  a group that is left “out in the cold” to fend for themselves and frequently resort to street fentanyl or just commit suicide by overdose as they are tired with fighting with the system.   

On a more positive note – The Veterans Administration system has started a model of an addiction specialist co-managing patients with a pain specialist and MD Anderson cancer center also has a model to deal with such patients. 

 https://www.mdanderson.org/publications/annual-report/annual-report-2016/nurse-prescription.html  

These multidisciplinary clinics are a rarity unfortunately and many pain “expert physicians” are unaware of them and would rather just either use a rapid taper or fire them and leave them on low doses of opioids. Until the system has enough resources with multidisciplinary teams to have the courage to deal with these patients, the opioid crisis will continue.  I welcome your comments and again appreciate all you are doing to help the crisis.  

SUPPORT DC, VIRGIN ISLAND, GUAM, AMERICAN SOMOA STATEHOOD

FOR NOW YOU ARE WITHIN

THE

YOUWITHINTHENORMS.COM , (WYNTON MARSALIS CONCERTO FOR TRUMPET AND 2 OBOES, 1984)

NORMS

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