Managing Pain

Ron Weaver knows pain.

The Kootenai County man also knows how to live with it, without narcotics.

But first, Weaver, 51, spent years following the advice of doctors, taking pills loaded with hydrocodone — an opiate pain reliever and controlled substance — and other similar drugs.

The medications were prescribed to relieve Weaver’s pain caused by ankylosing spondylitis, a chronic form of athritis that causes inflammation, primarily in the spine, but in other areas of the body as well.

Weaver shared his story Wednesday in Coeur d’Alene at Dirne Community Health Center’s second North Idaho Pain Summit, a gathering of health care, social service and law enforcement professionals who interact regularly with people who use controlled substances. The discussion was centered on prescription narcotic drugs with brand names like Vicodin, Roxicet and Percocet, and street names like “oxies,” “roxies,” and “hydros.”

“Over a period of many, many years I went from small doses of hydrocodone fives (pills containing five milligrams of the drug), to the point where, at the end of this journey, I was taking 360 hydrocodone a month,” Weaver said. “That wasn’t working.”

Ron Weaver’s story is not unique, and it represents just one element of the prescription painkiller crisis affecting the nation, not just Kootenai County.

The pain summit is part of an ongoing, local, community-wide approach to raising awareness of and finding solutions to the challenges medical providers, patients and law enforcement officials face when it comes to controlled substances.

The collaborative effort began in 2011 when Dr. Joseph Abate, chief medical officer at Dirne, shared some of his profession’s challenges with Coeur d’Alene Police Chief Wayne Longo and District Judge John Mitchell, who heads up Kootenai County’s Mental Health Drug Court.

Abate, Longo, Mitchell, Ron Weaver, Dr. David Wait, Dirne’s mental health director; Bat Masterson, an emergency room nurse at Kootenai Medical Center; and Dr. Scott Magnuson, a Coeur d’Alene pain management specialist all shared various aspects and approaches to the many-layered problem.

So many pills

Abate provided some stark facts.

• Hydrocodone, an effective but highly addictive opiate, is the most widely prescribed drug in the United States.

• Americans consume 99 percent of all hydrocodone produced in the world, and 83 percent of all oxycodone, another highly addictive prescription analgesic.

• There are enough narcotic painkillers prescribed in the U.S. to medicate every American adult for more than a month.

The tide of painkiller prescriptions began turning into the tsunami it is today several decades ago when the medical profession started taking an aggressive approach to treating cancer pain with narcotic analgesics, Abate said. There was an overall push to treat all pain more adequately.

“We took what we learned about the treatment of cancer pain, and transferred that to treat non-cancer types of pain,” he said.

Pharmaceutical companies began developing and producing different types of pain medications, Abate said. Purdue Pharma began marketing OxyContin, a potent controlled-release form of oxycodone in 1996. By 2001, sales of the drug were $1 billion per year.

There was no rigorous science, he said, to support the medical profession’s shift to using a cancer-related pain approach for non-malignant pain. The truth, Abate said, is that the constant blockade of the brain’s pain receptors leads to tolerance, dependence and addiction.

“In the long run, the pain is often worse,” Abate said.

The result, he said, is patients whose quality of life is diminished because of the medications they are given to treat their pain.

When the hydrocodone stopped working for Ron Weaver, his physicians added other potent narcotic pain relievers — fentanyl and morphine.

“The result for me was, there I was taking piles of stuff, just piles of stuff, and I still hurt. My brain and my body told me I needed the hydros,” Weaver said.

Weaver developed a fear of running out of the pills, and also began to realize, as he saw himself taking more and more of the hydrocodone tablets, that something wasn’t quite right. He eventually ended up at Kootenai Medical Center where he was admitted and medically detoxed.

Things changed very quickly for Weaver when he admitted to the physicians that were treating him that he was having a problem with the pain medications they’d been prescribing.

With the exception of one pain management specialist, Dr. Scott Magnuson, Weaver said “nobody was interested in my pain any more.”

“They had a drug addict on their hands, and they didn’t like that,” Weaver said.

He told the health care professionals attending the pain summit that they need to keep that in mind when treating a patient like himself.

“I got there for a reason. I wasn’t bored on a Sunday afternoon, looking for a six-pack of beer and a pile of hydrocodones,” Weaver said.

Patients “in trouble”

Abate said he often sees patients like Weaver.

“I think there are more patients who are in trouble rather than trying to get away with something,” he said.

At Dirne, the pain management treatment model includes a comprehensive assessment to determine if the patient seeking pain relief is at risk of becoming one of the 3.3 percent of chronic pain patients who become addicted to the medication.

Risk factors include a family or personal history of drug abuse; a diagnosis of depression, post-traumatic stress disorder or attention deficit hyperactivity disorder; and being a victim of violence or sexual abuse.

Abate said they check online court records to see if potential pain medicine patients have criminal histories.

“We look for felonies, drug charges, even DUIs,” Abate said.

Abate has a list of questions he asks patients, so they can help determine if they’re “in trouble.”

“I got to the end of this list and one lady broke into tears,” he said. “Nobody had ever pointed out to her that she might be in trouble.”

The woman asked for help.

Abate often helps these patients taper off their drug use.

A turning point for Ron Weaver occurred while he was at Kootenai Medical Center, after being detoxed. Dr. Magnuson came to see him and spent about 20 minutes with him, explaining how pain and narcotics affect the brain and the way pain is experienced.

“He told me, ‘The pain isn’t going to be as bad as you think,’” Weaver said.

It took months for the level of discomfort to diminish.

“The pain that my brain had worked itself up to was quite severe,” he said.

Weaver hasn’t taken any narcotics for three years. He now uses tools and strategies to deal with the constant aches he carries with him every day, and for those days when the pain level flares up from what he describes as a “five” to “an eight or nine.”

The dangerous side of the prescription pill crisis

There are other serious side effects caused by the glut of narcotic painkillers prescribed in the U.S.

• 40 people per day, 15,000 each year, die from overdoses involving prescription painkillers, and 82 percent of those deaths are unintentional.

• The rate of unintentional drug overdoses has tripled in the last 10 years.

• More people die from drug overdoses than from motor vehicle accidents.

Pain patients are often difficult to treat, for various reasons, Abate said.

“One out of seven will be trading your drug for their drug of choice,” he said.

Of the narcotics prescribed by the medical community, Abate said 75 percent are not taken for the purpose they were prescribed.

“It is not by coincidence that when prescription drug use increased, we saw a huge spike in property crime,” said Coeur d’Alene Police Chief Wayne Longo, when he spoke at the pain summit.

And there is other collateral damage, he said — abandoned children and family violence and abuse.

Coeur d’Alene Police Sgt. Mark Todd also spoke at the pain summit, and shared a long list of arrests of individuals in possession of prescription drugs that were not prescribed for them. In each case, there were other crimes involved.

The individuals in one of those cases were arrested with just five hydrocodone pills.

“They were dealing,” Todd said. “Maybe they were on the hunt for more in your house.”

The key to reducing the flow of these drugs, Longo said, is this partnering of the medical community, law enforcement and social service providers.

Ron Weaver has another idea.

“We need to teach self-pain management so that we are not turning to the narcotics as the only option,” he said.