My Most Dreaded Phone-Call: It’s the Coroner

“The Coroner is on the phone.”

At these words, my stomach clenches into a ball, and my hear pounds. Immediately I think: Which patient? What happened? Did I miss something?

Often times, the call is about an elderly patient that died peacefully at home. This last week the call got me analyzing a major issue in my practice and medicine in general.

KD was found dead at home. She was in her 50s. She was ill and needed  chronic pain medication for her disease. She took a lot of Oxycontin. While the final forensic results won’t be in for a long time, in my gut, I know it had something to do with the Oxycontin.

The dangers of narcotic pain meds are so enormous and yet often overlooked by patients and doctors alike. On the other hand, people are living with chronic and debilitating pain every single day. Is it fair to withold medications from a woman with Stage IV rectal cancer because she may misuse it? Or, do we prescribe freely and put the responsibility on our patients to follow instructions to the letter?

Then, of course, there is the issue of addiction, and the enormous street value of these drugs.  A young man “in the know” told me once that an “Oxy” goes for $20 on the street. So, my script for a one month supply of 60 tablets is worth $1200!!! That is a lot for any one in a financial bind—or desperately needing a fix they can’t afford.

The actual number of  unnecessary deaths from these drugs is a hard one to figure but all would argue it is too high.

I have thought about having a rock solid policy where we don’t prescribe any narcotics ever in my practice. That is not reasonable, practical or fair to my patients who need these medicines for appropriate conditions.

I have devised a pain management contract that all patients on these drugs must sign–as of now, that has not gone over well with patients.

I look every chronic pain patient in the eye when we are dicussing threir meds. I try to read them. I try to pick out the few that might be in danger of over/misusing. But, clearly, that approach has been next to worthless. I either miss the signs all together, or my patient gets the feeling that I don’t trust them.

I believe the answer lies much deeper than the policies and practices of one small practice and a few patients. We need a grass roots effort in this country educating doctors and patients alike about these dangers. In that effort, we need to understand how to balance the dangers against the sense of ostracism these patients have.

After my last C-section, my doctor gave me a script for Percocet. I was mortified handing the script to the local pharmacist and actually contemplated driving further away so they “wouldn’t know me.” And, this was a one time script, for about 10 pills. It wouldn’t raise anyone’s flag…but it sure raised my own.

Is it enough to stare someone in the eye and try to read their intention, understanding, and true need for these drugs? Or do we swing full circle and stamp our feet and “Just Say No?”

Are you on Oxycontin or other pain medication and want to share your story? Do you know someone that had a problem with pain medications whose story we may learn from? Please share your comments anonymously below. Clearly a conversation needs to happen–before I have to have another one with the county coroner.

Comments

  1. Mehwish Siddiqui says:

    Dr. Meyers, I agree and am a witness to your “knowing your patient” process when you prescribe or recommend a narcotic to your patient. My husband H and I are your patient for the last 7 years and back in 2009 , H under went a kidney surgery. The nephrologist wouldnt prescribe him any strong medication for post surgery pain. He kept prescribing over the counter analgesics which were of little or no use. Finally, H called you and you took him in immediately. You went over the details of his surgery, spoke to him, examined him and all through this I saw you “reading” H. I was in the room also to explain my concerns about H. You precribed Percocet twice and that was it. Noone got addicted and once the pain was gone, so was the bottle with its remaining pills down the flush. I believe reading the patient does help to an extent. When you talk to them, it gives an idea somewhat about them and their personality. It also depends on the patient and his sense of responsibility as to how far will he take this addiction. In the end, you did what you thought was right and you try your best till the end but life is not perfect and we can not control or change the sad endings.

  2. Christine says:

    Great great illustration Mehwish–Thank you so much for sharing. There is most definitely a place in the middle–I just wish it was clearer to prescriber and patient!

  3. Ellen Wallenstein says:

    Dr. Meyer,
    As you know I was one of those patients who didn’t take the implementation of a pain management contract very well. I had a knee jerk reaction to it, felt it meant you didn’t trust me personally. It’s hard not to feel that way with the stigma that is attached to being on such a medication. I get the stares at the pharmacy each and every time I go in, sometimes with lots of whispering between two pharmacists before they agree to fill the prescription. Each time I’ve switched to a new doctor (we’ve moved several times over the years) I face that first meeting with such dread, wondering if I’m seen as a drug seeker. But I can also tell you stories that show the another part of the problem…a teenaged son who abused opiates along with other over the counter medications. His description of pill parties he attended where bowls of pills were available because the kids who attended raided their parents medicine cabinets for old, left-over and forgotten prescription bottles. Kids would just reach in and take a pill with no idea of what they were taking. He was astonished at how easy it was to access these pills. On his first day back to school (high school) after rehab (successful!) he ran into a kid he barely knew who offered him a Vicodin, not for the normal $2 but for free because he had missed him the past few weeks and wanted to welcome him back. These pills are out there in scary numbers and I would urge anyone on any kind of controlled substance, whether it be pain meds, sleeping pills or anti-depressants to lock their medications up. I know it would have saved my family a lot of heartache in the end. I think too many of us think “not me, not my kid”, I certainly was one of those people. As to the patient who overdosed I will say this…I’ve been that low in my life, it’s hard to live with chronic pain, to come to terms with the idea that your life will never be the same, but I think the sad truth is if she didn’t have access to the pills she would have found another way to end her pain, if that was her goal. I’m so sorry for you and her family because she obviously didn’t feel she could share her real pain, that of losing hope.

    • Christine says:

      Ellen
      Thank you so much for sharing this very personal story so very openly. I know that it will touch people on so many levels. You are right, our kids are in trouble. We need to do something. It has to start with diligent patients AND doctors….the onus is not on one alone. Again, thank you so much…I know how hard it is for you to speak so openly on this topic.

  4. Kat says:

    Hi my favorite doctor!! I’m not ashamed to admit that I had a problem with Xanax. Not that it was as hard as Percocet but I was using it every single day, at night. I needed it to go to sleep, or so I thought! Well, Amy shocked me one day by saying ” I think we should ween you off slowly!” I thought this lady was nuts, how would I sleep? It was a tough to hear those words from her and to be very honest it made me feel broken, shameful even. After a brief stomping of my feet I stopped using anything to fall asleep.l stopped cold turkey and after two nights I felt like a new person! I was so well rested. I can’t thank your office enough for putting a stop on it! My husband has some here from flying to Germany and the bottle is almost completely full( he used two) neither one of us has any urge not to be in complete control of our bodies!
    I can see how easily Percocet can become an addictive substance and truly wish that drug abusive in general was taken more seriously in America. It seems there’s a pill for everything lately! Weight, happiness ect! Grateful to have doctors that listen and understand me so well!

  5. Jeanie says:

    You can only do so much. My husband’s ex-wife has been addicted to prescription drugs for a long time. She “doctor shops” and goes to different emergency rooms screaming for meds. Maybe someday, instead of giving your name in the emergency room, they’ll use our social security number, which should be used for tracking drug use. It’s a sad situation.

    • Christine says:

      Kat
      Thanks for pointing out that the benzodiazepines can be just as dangerous as some of the other meds we are discussing. And, thank you for reminding other patients that when their doctor or provider questions them..it is really out of concern and caring for their wellbeing–not ouf of distrust. So proud of you for stopping the xanax and for being willing to speak openly so others may benefit.

    • Christine says:

      Jeannie
      You are right, we can only do so much. If a patient wants or needs a drug badly enough they will find a away to get it. But, it does start with a prescription usually. That first contact with the drug is where we may be able to make a difference…

  6. Marlene Matarazzo says:

    My name is Marlene Matarazzo. I am a long time patient of Dr. Meyer’s practice and I am thankful for her knowledge and compassion. Both have been invaluable to me and my partner for years – through mild to serious medical issues. I unfortunately am a patient who has to take chronic pain medication due to severe pain episodes caused by a debilitating back condition. I have a Spinal Cord Stimulator inplanted to try to help me manage the pain, unfortunately it can just do so much. That is where the pain medication comes in to help me keep as mobile as possible. Let me say here that I hate being on the pain medication prescibed, but I am also grateful for it – for you see, without it I would be a lump just laying down all of the time – unable to move much. I no doubt would be a pain to be around – grumping at those around me who thankfully love and support me so much. Pain makes you strike out sometimes at those you love the most because you are so frustrated by the pain and so tired of it being in your life and controlling what you do, when you do it, and “if” you do it at all. Chronic pain is a lonesome condition since it controls so much of your life. Chronic pain makes you think about everything you do before you do it. For instance if asked to go somewhere, I have to question the person who asked me things like how far will I have to walk, what are the chairs like that I will sit in (chairs that tip back even a little bit cause me alot of pain) I ask how far of a drive is it (while I no longer drive, riding in the car for a distance is a problem for me pain wise), how many stairs will I have to navigate? Will there be an intermission so I can stand and stretch? Just a few questions that have to be considered before I can go somewhere. One of my biggest personal problems with being on pain medication is that it hurts my pride and self-esteem to be labeled a “drug abuser” by some that don’t understand what it is like to live in chronic pain. I have what I call pain episodes which happen when I suddenly get a hot/electric jolt of terrible pain that causes me often to fall and sometimes pass out from the intensity of the pain. I hate this most of all. I have no control over it dispite trying so hard to stop it from happening. I have learned that I cannot will it away; try as I may. This is where my pain medications help to soothe the pain somewhat and it gets me through until the pain lessens and I return to “normal” whatever “normal” is for me. I just want people to know that I am more then my pain. I am not a drug abuser. I do not seek out drugs from different drs. (Dr. Meyer manages all of my medications). I am in fact hesitent to take my medications as I don’t want to be labeled “that addicted patient” . I am a former drug/alcohol and mental health coordinator at an out of state social sevices setting. I know the effects of drugs on an individual and it scares me silly. While I have come to accept that I have to take my pain medications in order to live as normal of a life as possible, I just want people to know that I am not defined by the drugs I have to take. I am a person stuck in a very difficult medical situation due to my medical conditions. Please do not label me. Please see me for who I am. The Pain Management Agreement that Dr. Meyer mentions above is so hard for me to accept as it is worded so strongly and seems to point a finger at everyone who signs it. A finger that paints every patient with the same brush no matter how different we are all from each other. Everyone on pain medication is not a drug abuser. Some of us just have to take pain medications in order to move about the world in as normal a way as possible given our pain situation. I know Dr. Meyer understands this. She is, as I said before, a very compassionate person. I truely believe that she sees each person she treats as different – with different peoblems and different needs. I guess I just needed to vent about feeling labeled and about the content of the Pain Management Agreement. I hope it can be revised in some way to fit the individual person rather then the mass. Thank you for letting me vent. I appreciate it.-Marlene

  7. george says:

    Should you really be talking about your patients and what happens to them? Initials and changing their names is all fine and good, but do you think you should be doing that at all?

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