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
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