A physician learns her patient has a drug problem

After being a patient of mine for nearly a year, an elderly woman came into my office for a follow-up visit. She had been what we physicians would consider a “good patient”: never canceled appointments, never asked for early prescription refills, never claimed she’d lost a prescription and needed a new one.

Always well dressed and conversational, she looked every inch the kindly grandmother that she was.

So I was taken aback when she anxiously told me, “I’ve been lying to you.”

Twelve months earlier, her primary care physician had referred her to me, a pain management specialist. After a detailed assessment of her pain issues and a thorough physical examination, I prescribed an opioid to manage her chronic pain. Opioids are intended for pain relief in certain indications, drugs you’ve probably heard of: oxycodone, hydrocodone, codeine, fentanyl and others.

Now, through her tears, my patient explained that the lies started when she told her primary care physician that she had transportation issues and could no longer make the trip to my office to continue her pain management regimen. Her primary care physician then began prescribing her the same pain pills I was prescribing.

Now, after nearly a year of doubling up on her pills every month, she was finally confronting the truth: she may have become addicted to opioids.

Her story is becoming frighteningly common. It’s estimated that more than 2 million Americans are now hooked on prescription pain pills (PDF) on prescription pain pills. And this is an addiction that can kill you.

According to the US Centers for Disease Control and Prevention, more than 183,000 Americans died from overdoses of prescription opioids between 1999 and 2015. That’s more than 1,000 people each month.

And the rate of these deaths is increasing. In 2015 alone, there were more than 20,000 fatal overdoses from prescription pain medicines in our nation.

Lawmakers and medical professionals are working together to find policy solutions that will help control the growing problem of prescription painkiller addiction. Many researchers believe addiction to prescription opioids can lead to the use of deadly illegal drugs like heroin.

From my perspective as a physician, this patient’s behavior raised no red flags before her emotional confession in my office. I took some solace in the knowledge that there was at least one other physician – her primary care physician – she’d managed to fool. But neither of us should have been too surprised to find we’d been unwittingly supplying her habit. The “typical” person with addiction in the 21st century isn’t what he or she used to be.

America has been dealing with opioid problems for many years, including a large wave of Civil War soldiers who were prescribed morphine for pain and ended up becoming addicted to the drug. But in truth, these kinds of drugs were available illegally long before that. Some eventually became legal medicines; heroin was sold in the early 1900s as a cough medicine.

But what’s different today is the pervasiveness of the problem. A survey from 2016 found that almost half of Americans know someone who has been dependent on prescription pain pills. Certainly, many in the other half also know someone abusing opioids, but they’re just not aware of it.   

When we hear the words “drug addiction,” most of us probably conjure the image of a dope fiend in a darkened alley using a needle or a scarred, zombie-like junkie passed out in a crack house. But the 21st century has added a new profile to drug abusers, and they look very “normal.” They are our friends, our co-workers, our family members, perhaps even our grandmothers.

My experience with this patient reminded me that anyone taking prescription opioids has the potential to become dependent or even addicted. They may not be sending out obvious signals of a problem; they may be able to function in their jobs and family relationships for some extended period of time; they may not even believe that they have a problem at all.

But their addiction can be every bit as powerful as the stereotypical drug users we see on television. And their habits can be every bit as deadly.

Addiction has no face, no race or gender, no age or education level. Anyone from young people to grandmothers can become opioid abusers. As a physician, I urge my colleagues in health care to take a few simple steps that could help prevent patients from inadvertently becoming addicted to prescription opioids:

• First, before writing an opioid prescription, check the Prescription Drug Monitoring Program (PDMP) database to learn the patient’s prescription history. This could help prevent “doctor shopping” and diversion. The PDMP is a free tool that is available to all prescribers.
  
• Limit the number of pills in the initial prescription for acute pain.
• Explore e-prescribing as a solution to reduce the risk of forgeries of paper pad prescriptions and lost or stolen prescriptions.

Physicians need to take advantage of all of the available resources including proper risk assessments at the first visit, pain management contracts, ensuring patients have a clear understanding that medicines must be used responsibly, discussing the risks and benefits of starting on opioids (informed consent), and considering alternatives to opioids for managing pain.

Consumers can also play a role in preventing opioid abuse: medications must be safely stored and out of the reach of children; unused medicines must be disposed of properly; painkillers must be prescribed by a single physician.

I learned some important lessons from that kindly grandmother that changed the way I practice pain management, and as we worked together to address her drug dependence, she learned some important lessons from me. But the most important lesson for both of us was that we can’t possibly know who among us might become a drug abuser. 

If you think you may have a problem with opioids or any other type of dependence, don’t be afraid to seek help. If you don’t know where to start, try talking to your physician. If you don’t know what to say, start with, “I think I might have a problem.”