I never wanted to be a drug pusher. A career in medicine was the opposite — healing in place of harming. However, I knew something was wrong when a detective asked to speak to me about one of my patients. My patient, addicted to Vicodin, had committed several acts of fraud and theft in desperate attempt to satisfy her needs. Her arrest was the final step in a long, slow unraveling of a happy and productive life. I was not just a witness to this painful process; I was an active participant. As her primary care physician, I helped fuel her addiction and shared in the responsibility.
When the history of the opiate epidemic is written, I suspect most physicians will add stories that humanize the crisis we helped to create. My patient was married, with two children, a comfortable home and a job in health care when I met her. We quickly established a rapport, and I became the physician for her husband and children. A few years later, she injured her back in a minor car accident. We tried physical therapy, acupuncture, epidural injections to treat her constant back pain. It seemed, however, that the only thing that worked for her was the Vicodin. Her work suffered, she was frequently “sick” and needed time off work. She was unable to maintain a normal family life, and she and her husband began having marital problems. The crisis at home deepened when her eldest daughter tried to commit suicide and was subsequently hospitalized.
Shortly after, I confronted my patient regarding her escalating quantities of Vicodin and my concern that she was addicted. She reluctantly agreed to adhere a strict contract and begin the process of tapering off the medication. But at the same time, she began a second life, stealing medical record information from other patients and filling prescriptions in their name. She also stole one of my colleagues prescription pads and began forging narcotic prescriptions. She would sometimes drive eight hours to the far reaches of the state to obtain her daily need Vicodin. Her life imploded, spectacularly, when she was arrested at work and escorted out in handcuffs.
The opiate epidemic continues to ravage communities, families, and lives; emergency room visits for opiate overdose have increased 30 percent in the past year. Primary care physicians make difficult choices every day, as we continue to fill prescriptions for our patients suffering and in pain. It is time for physicians to kick the habit and start over — we have hit rock bottom. Hope for lifting us out of this crisis lies in our greatest asset: our relationships with patients. But this in itself is not enough.
Working collectively, primary care physicians at my medical center have reduced chronic narcotic pain prescriptions by almost fifty percent in the past three years. Family physicians, working hand in hand with pharmacists, pain, and addiction medicine specialists and support staff, have been successful in helping many patients find their way back from addiction. In the past year, we have been able to successfully taper some of my patients off narcotics. This seemingly impossible task was made possible because my patients trusted I wanted what was best for them and were willing to work with other providers to make it happen. One of my patients was gradually tapered off high doses of Percocet and fentanyl after taking it for years. At the end of a recent appointment, with tears in her eyes, she hugged me and said, “Thanks for my life back.”
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