Guest Post by Mark S Ibsen MD

We got a refugee problem- right here in the good ol USA.

Mike teared up. He said “the thing I love about you Mark is that you’ll see anybody won’t you?”

My eyes got wide, and I said “of course-what else would I do”?

Mike was referring to the 22 “narcotic refugees” that I began seeing last April. Their doctors’ office had been closed in a DEA raid. The doctors license was suspended indefinitely by the state board. In the intervening eight months, no charges have been filed against that doctor, and his license remains suspended. His practice is ruined. Defunct.

But his patients have had to fend for themselves,obtaining treatment for their chronic pain issues. Some of them (21 or 22) ended up coming to see me in Helena.
It is often said that Montana itself is one small town with very long streets. We just passed 1 million population in the last year or two.
So going to couple hundred miles to see another physician is not that big a stretch for my imagination, but it is considered a red flag for possible drug seeking or diversion according to pharmacists in my area, and certain agencies.

So when my friend Mike got teared up about my service to these so-called narcotic refugees I found myself a little perplexed.
Of course I would see whoever comes through my door, particularly if they’re suffering. And, I don’t care if they’re having acute pain or chronic pain if they’re in withdrawal and have been abandoned due to actions of their doctor or a pharmacist or a state or federal agency it doesn’t matter to me. This situation called for a response along the lines of the good Samaritan. I wouldn’t drive by a car wreck,an unconscious fellow citizen lying on the ground, and I certainly wouldn’t fail to respond from a call from the cockpit on an airplane flight.

I am wired to respond with my skill set when a contribution is needed(been an ER doc for 31 years).
Of course I was shocked and chagrined when I heard that the unintended consequences of an action against a fellow physician was the closure of his office, confiscation of his records and abandonment of all his patients. I know that if I did that in the course of MY medical practice I would lose my license immediately, And rightfully so.

So my automatic response in seeing the first patient on April 14 was to “spring into action”.
I wasn’t necessarily thinking about consequences to me or my license I was thinking mostly about the consequences to the patient in front of me for being in withdrawal is an acute pain. I was concerned about the betrayal this patient was suffering from. He couldn’t find his doctor-his doctors office had crime scene tape put up across the door and he didn’t know what to do. Phones were shut off.
Granted there were articles in the county paper about patients doing a “rapid wean” with the medications they had left, but no indication about where any of these patients could go to find alternative care having had their primary caregiver taken from them. The announcements from the county health department: no urgent care or ER in that county would prescribe for these patients.

As I reflect about it at this time of year, it seems like “there was no room at the inn for them.”

Now I find myself under investigation by the State Board of medical examiners.The attorney for the board has requested that the DEA investigate me. Two agents came to my office to interrogate me about my practice. While I found this somewhat terrifying, I thought the answers I gave were appropriate and responsible.I told then in no uncertain terms that I don’t run a pain clinic-I operate an urgent care clinic. I also told him that I’m concerned about red flags also.I even notified them that several groups of related people were coming to see me from that previous practice. This looked initially like a potential “family business”.

I assumed that informing the agencies about this would satisfy my obligation to make them aware that there might be some people who could be breaking the law. Of course it’s also plausible to me that each of these patients had a good reason to be on their high does opiates. I considered it to be a secondary issue however, since I had access to the Prescription Drug registry, I could see that each of these patients had been on very high doses of opioids for a long period of time obtaining them consistently from one provider(they were forced to use an increasing number of pharmacies, having been turned away from the local ones-that’s a different article)

Of course their doctors records were unavailable as they had been confiscated. I did not feel I needed medical records in order to treat a person who is in pain and in withdrawal. I consider them to be in a metabolic and physiologic emergency.
Just like I would treat anyone who’s dehydrated or having A heart attack – I would not care about their previous records during the initial phase of evaluation.

After eight months most of these patients have weaned or moved on: several I’ve tried to refer to pain clinics out of town to no avail. And there is no actual prescribing pain clinic operating in my town.

Those out of town pain clinics require pill counts to be done randomly, and so the patient must live within an hour of the medical center in order to do the pill count. Therefore they won’t take any referred pain patients. They also won’t take any patient of the doctor whose office was closed. He is now a pariah. All of his patients are being discriminated against. No other physician is willing to see these patients. They are truly “opiate refugees”.
Yes, this appalling behavior is occurring right here in America, the land of the free, And home of the brave. One of these humans: a veteran critically injured by an IED in Iraq.

Oh, and the doctor whose office was closed? No charges have been filed against him so far. Meanwhile I’m scrambling to save my license because I’ve been accused of over prescribing narcotics to these patients as I have weaned them.

During this last eight months I’ve learned a lot about chronic pain, high dose opiate use, and the aphorism: “no good deed goes unpunished.”

While it seems like an obvious assumption that pods of family members moving in a group to obtain opiates would likely be diverting these, that didn’t seem to fit this whole scenario. I ultimately found a DNA test for opiate sensitivity.
The pod members that I have tested for this have uniformly turned up positive for “rapid metabolizer” status, indicating a need for high dose opiates to relieve any pain at all.

Naturally, and somewhat obvious at this point, genetic abnormalities run in families!

While two of these 22 patients did alter prescriptions,and are no longer obtaining prescriptions from me, it is not clear whether those alterations were done in order to divert(sell) or a manifestation of pseudo-addictive behavior (felony nonetheless).

There has been a change. It’s a radical change. Our patients are no longer our patients. The patient physician relationship is in jeopardy.
Right now,FEAR is the operative modality.

I am now finding more and more that pain truly is a freaking terrorist.
And terrorism has people sometimes behaving at their best, and sometimes behaving at their worst.

We actually get to choose, don’t we?

Mark S Ibsen MD
Urgent Care Plus
39 Neill Ave
Helena Mt 59601

12 Responses

  1. Anyone who has ever suffered the horror of opiate withdrawal without help can tell you that it is a living hell. Those 22 patients were indeed “medical refugees”. Why they were on pain meds and for how long, etc, would certainly have been important questions that needed answers during their ultimate treatment, but for that moment, after they were essentially being “cold turkeyed” by the DEA, they did indeed need immediate treatment, and yes, “urgent care”. Thank you, Mark Ibsen, for doing the right thing, thinking first of the patient who was, if not, yet, soon to be in an acute withdrawal. Make no mistake…withdrawal can kill…in one way or another.

  2. The DEA is focusing on the wrong people. Let Doctors do their thing. With the fear they are instilling in everyone, doors are getting slammed on those that need help. Dr. Mark is right in that pain is a terrorist and pain leads to mischief. The line is fear. I pray it doesn’t fuel the problem, I’m afraid it will.

  3. Anonymous – you are missing the point. There is no line being drawn between doctors and their patients. It is a witch hunt brought about America’s government and their need for profits to substantiate their so called today’s crisis. Doctors are scared – pharmacist are scared – patients are being left to suffer for unacceptable reasons all due to threats and intimidation by our so called government. Let us hope that those that don’t get adequate help don’t go to other means to ease their pain as this will only give our government and DEA more ammunition. In the 80’s of the child abuse allegations and witch hunt by our government what ended it? Publicity and absurdity. Of course, by the time it was fully revealed, all higher people in government tried to remove themselves from it. Is this any different? If we want to make a difference we once again need to get a public campaign going show casting American’s suffering at the hands of government. If the DEA was really concerned they wouldn’t be targeting legitimate doctors and pain patients but focusing on the streets where the real drug deals are being made. But, wait, they might have to really work then and stop intimidating innocent people to pad their pockets and making innocents suffer to support their job! If we are going to make innocent pain people suffer then lets stop the DEA – its not worth human suffering! DEA or human suffering – bet it would be easy if you were in severe pain!

  4. This whole case is just baffling! Dr. Ibsen has done nothing, but be an amazing physician. As someone who deals with chronic pain, it’s pure HELL if you don’t have a compassionate, understanding doctor on your team. The line that is being drawn between patients and doctors is going to be deadly. Those that can not get adequate will go to other means to ease their pain. THAT is the real problem! Get the Meth Heads that prey on unsuspecting victims in hopes they become addicted!!! Not the Doctors who are here to help!!!

  5. America’s government has always had a need for a witch hunt and a band wagon to stand on. How can DEA people with no medical background investigate and judge the prescribing of a legitimate medical doctor. Statistics? People and pain suffering are not statistics. I suffer from headaches but have never needed anything stronger than motrin. However, I make sure to never run out of motrin! I have friends that also suffer from headaches but motrin does nothing for them to relieve the pain. Sadly, they no longer have the means to make sure they never run out of the medicine that controls their pain. So, DEA, tell me how statistics prove why one gets relief from motrin and the next one doesn’t. Pain is pain and should be dealt with – no one should have to suffer needlessly in the name of Government! And our country should not still be running on witch hunts, fear and intimidation. I hope this becomes a big focus point in the next election. 2015 and we still have witch hunts – sad!

  6. Going a couple hundred miles to see another physician is normal for Montana. I was being treated locally with 1940’s era medications that made my neurological condition worse, but masked my symptoms. So I asked my primary care physician about neurologists in nearby communities and found a specialist who is helping me with better knowledge and technology. It is normal Montana behavior for us to drive 91 or 124 miles over treacherous mountain passes to medical appointments. It’s kind of like driving across town for a second opinion in a big city. No, I do not have chronic pain issues, but as an example, my friend with a ruptured disc did. She went to California to renew her prescriptions. Now that is more of a red flag for pharmacists and agencies that might have helped her obtain more effective treatment with physical therapy and/or strength training instead. But until her pain was relieved, she needed to be weaned from the pain medication in a way that would not cause her more pain plus the throes of withdrawal. By the time I met her, the other discs had begun to “unzip” on either side of the original rupture and she was diagnosed with degenerative disc disease.

    There is a reason Dr. Ibsen’s patients become his friends, and why we get “teared up” when we find out about how the DEA is persecuting him after raiding the doctors’ office of the “narcotic refugees”, suspending that doctor’s license indefinitely, ruining his practice, closing his office, confiscating his records and abandoning all his patients. Many times Dr. Ibsen’s Urgent Care clinic is the only place we can go to be sure of quick, skilled medical care from compassionate, knowledgeable healthcare professionals that actually listen to us and accurately observe and help our needs. The thought of this facility being “defunct” brings to mind long, bleeding, painful waits at other “urgent” facilities with unsatisfying 2-minute “consultations” with someone who fearfully prescribed the current politically acceptable remedy, whether or not it is what we actually need or want. Again, I am not a chronic pain patient and have never used (and hope I never will use) narcotics. But I’ve received accurate diagnoses and effective treatments from Dr. Ibsen for nearly broken arms my friend’s spoiled backyard colt kicked, and an ear infection that tortured me for months. My primary care physician could not see me for days, the ear specialist for weeks (months?) and the local hospital’s Urgent Care prescribed muscle relaxers and pain pills when my employer sent me there when I had an injury at work. They refused to refer me to my regular practitioner when I asked them, and instead had me go to their physical therapy department to teach me to push on my displaced ribs myself in order to relieve the pinch in my lower back (!?!) Yes, I would rather go to someone who listens. Dr. Ibsen even took a brief and accurate history of my neurological condition and helped me research additional effective treatments for it during his consultation for my ear infection. For the first time is decades, I felt professionally medically cared for.

    Dr. Ibsen and his Urgent Care facility need to do their good work in freedom, not fear.

  7. They told me I was risking my license and FREEDOM by prescribing to people “like these”
    Of course I asked why I should actually DO?
    They said: ” we cannot tell how to practice, we’re not doctors.

    Reminds me of a movie.
    “Make him an offer he can’t refuse…”
    Too vague for any written communication or guidelines. No one responsible but me.

    • Reading between the (DEA) lines:

      1. Addiction is not an ER or “urgent care” problem.
      2. Only specialists can prescribe drugs to drug addicts (if then).
      3. Most (if not all) chronic pain patients are drug addicts.
      4. DEA agents have bigger egos than doctors (if that’s possible).
      5. Agents are not used to being questioned, but they are used to being feared. Therefore, you better do what they say, or else…
      6. Any questions?

  8. Mark. Its almost like they set you up in a way because you are the kind of doctor that will do anything to help anyone. You don’t discriminate against anyone and all you see is the person. Its sad these days that you have to put your humanity to the test and not just be a humane person. I’m glad you helped those people because they will remember it and God will bless you in the end. I know its been a hard road but it will work out.

  9. Love this post. I have been seeing Dr. Ibsen for more then two years now and all that I have received from him is the up most respect for his patients. Not only has he helped me with my chronic pain from severe depression. But I also have seen him for HRT. He is my favorite Dr. and I would not go to anyone else. Unless it was something that he couldn’t take care of. Which in my time with him has seen zero concerns that he couldn’t handle. Mark was the first Dr. that I took my fiancé into his office due to her chronic headaches when her regular physician would not let her have the right to have a cat scan. Mark on the other hand had no problem with this and the next week my fiancé was going in to get her cat scan. You are a great Dr. Mark don’t let the terrorists win there are many people like me that need your help.

    This case is reminding me of my favorite Dr. off of TV. Yes I will say it Dr. Ibsen is like Dr. House. He works in a way that some people don’t understand but in the end he solves the problem that the patient is having.

  10. Perhaps because I have been so mistreated by doctors, I have little sympathy for them — but that doesn’t keep me from having admiration and respect for those that fight back, especially against the DEA.

    But I’m curious… If you could go back in time, what should you have done with those 22 patients? I mean, what did the DEA expect you to do? Am I to assume that refusing treatment is the only option the DEA considers appropriate?

    And I don’t know about any other Americans or chronic pain survivors, but I’m going to be extra careful the next time I am forced to report to a doctor on my disability. I’m sure the DEA depends on frightened doctors to squeal on certain patients, but people usually don’t take drugs just to take drugs — unless they have a problem with addiction. Which, by the way, is a medical condition, not a crime.

    Now, we can leave it up to the DEA to decide when someone’s addicted, or how many milligrams a pain patient can have every day, or the medical industry can grow a backbone and fight back, like Dr. Ibsen…

    In my opinion, it’s already too late — Dr. Ibsen may win this battle, and I hope he does, but the DEA has already won the war.

  11. I honestly couldn’t agree more with the doctor. It’s a shame what those go through in regards to pain medicine. This isn’t fair or right what they are doing to you. I would continue to prescribe with more caution basically is what they are getting at by visiting you. You are still a medical doctor with the knowledge to know what to do for your patients.

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