When Is a Pain Doctor a Drug Pusher?

NY Times ^ | June 17, 2007 | TINA ROSENBERG

[neverdem]

Ronald McIver is a prisoner in a medium-security federal compound in Butner, N.C. He is 63 years old, of medium height and overweight, with a white Santa Claus beard, white hair and a calm, direct and intelligent manner. He is serving 30 years for drug trafficking, and so will likely live there the rest of his life. McIver (pronounced mi-KEE-ver) has not been convicted of drug trafficking in the classic sense. He is a doctor who for years treated patients suffering from chronic pain. At the Pain Therapy Center, his small storefront office not far from Main Street in Greenwood, S.C., he cracked backs, gave trigger-point injections and put patients through physical therapy. He administered ultrasound and gravity-inversion therapy and devised exercise regimens. And he wrote prescriptions for high doses of opioid drugs like OxyContin.

McIver was a particularly aggressive pain doctor. Pain can be measured only by how patients say they feel: on a scale from 0 to 10, a report of 0 signifies the absence of pain; 10 is unbearable pain. Many pain doctors will try to reduce a patient’s pain to the level of 5. McIver tried for a 2. He prescribed more, and sooner, than most doctors.

Some of his patients sold their pills. Some abused them. One man, Larry Shealy, died with high doses of opioids that McIver had prescribed him in his bloodstream. In April 2005, McIver was convicted in federal court of one count of conspiracy to distribute controlled substances and eight counts of distribution. (He was also acquitted of six counts of distribution.) The jury also found that Shealy was killed by the drugs McIver prescribed. McIver is serving concurrent sentences of 20 years for distribution and 30 years for dispensing drugs that resulted in Shealy’s death. His appeals to the...

[cripplecreek]

My friend in Canada has a mother who is addicted to oxycontin related drugs. She had lung cancer but has been cancer free for 5 years now but the doc still prescribes the pain meds.

[P-40]

My doctor would not proscribe me pain meds even when I introduced him to my (now) ex.

[Ramius]

If somebody has chronic pain, who cares if they are addicted to whatever makes their life bearable? So what?

[darkangel82]

I don’t see any reason for this guy to be in prison for 30 years.

[O Neill]

I don't believe anything published in the NY Times...

[JmyBryan]

Technically, when he obtains his license. Or, don’t doctors make their living selling drugs?

[Grammy]

Dr.s really don’t know how to treat pain, and in fact are afraid of it. I have a friend with chronic pain. She is never pain free, and in fact goes merely from tolerable pain to intolerable pain. They prescribe her pain meds, then at the end of the year look at what she has been taking and go “OMG, you are taking too much!!!” and cut her meds thru the end of the year, making both the winter time and the holidays miserable.

Her pain is affected by many things, including the weather, yet they will give her a fixed number of pills. Period. If she has a bad spell, she goes to bed, rather than take an extra pill, because then she will not have enough to last the month. She is not on oxycontin, but something milder. Yet they won’t give her an extra day or two of her prescription, because it looks bad.

So, what is better. To be not addicted to pain pills, and suffer unbearable pain and have no life because you are in bed, or to be addicted to pills and be able to function and live a life.

[Sammie42]

Sometimes we have to make hard decisions. I am not concerned that I may become addicted to my nerve pain medications. I would be deprived of a full active life without it. Life is full of choices, we attempt to make the right

[cripplecreek]

Oddly enough, my friend’s mother’s pain seems to get worse as she nears the end of a bottle of oxy.

Gotta figure, it’s Canada so the government is paying the bills and it’s easier for the doc to leave her addicted than to try to struggle through withdrawls that will result in a longer life if she breaks the addiction.

[Ronin]

This situation is crazy. We have people in America with chronic pain AND terminal illnesses who can’t get relief — or at least not a sufficient amount of relief to make what’s left of their life barable.

Yet, doctors are afraid to prescribe sufficient painkillers to do the job because they are afraid of ending up like this guy.

Color me stupid, but if a person is dying anyhow, it seems to me the last thing the doctor should be worried about is whether or not the patient is going to get addicted to the meds.

[mo]

“....serving 30 years for drug trafficking,”

A conviction like this beats the snot out of having to deal with some Mexican border hopping dealer with a fast trigger finger..... (and I REALLY don’t mean to hijack this into an immigration thread....but IMHO is pretty darn near the truth here...)

[stephenjohnbanker]

BUMP

[KoRn]

"Yet, doctors are afraid to prescribe sufficient painkillers to do the job because they are afraid of ending up like this guy."

You are exactly right, and it's an outrage. I am a chronic pain patient. I get meds, and one time my doctor told me what the DEA does, and how even honest doctors treating real patients can get into trouble just for doing their jobs. Every month the DEA pulls many random DEA numbers of physicians, and then go through the physician's office like the IRS would go through a cooperations books for an audit. He said they just assume any patient getting pain meds is a criminal, until proven otherwise, and they look upon the doctor with suspicion for prescribing such medicines. The doctor told me that he, or even I could go to jail if his records were anything less than perfect. I'm sure many people are suffering right now because their doctors are simply unwilling to put up with all of that...

[seacapn]

I’ve felt for a while that prosecutors and drug agents should be charged with conspiracy to commit murder if their actions cause pain patients to later die due to insufficient treatment. I can only hope that some of them, sooner or later in life, suffer chronic pain themselves, and find themselves hanged by their own belts, so to speak, when their own efforts to seek relief are blocked.

[gas_dr]

Dr.s really don’t know how to treat pain

Like so many other perjorative statements, this is completely incorrect, and in general, pretty ignorant. Doctors DO know how to treat pain. I am a board certified anesthesiologist, and believe me, I treat pain very, very well. There are two competing problems here, one is societal and one is patient oriented -- first things first...

As usual, society COMPLETELY uses the wrong word with all its miserable connotations do define a problem. People with chronic pain do not become ADDICTED to pain meds, the become tolerant of them. When properly administered, pain meds, specifically narcotic reduce the amount of pain felt. Over time it take more and more of the drug to achieve the same pain relief. This is TOLERANCE to the drug. As the patient becomes more tolerant, the dangerous effects of the drug are also better tolerated.

The prime concern with pain medications is a DANGEROUS decrease in respiration -- namely the patient stops breathing. In someone who is not exposed to pain meds on a regular basis, a high dose can be fatal. The same dose in a patient with chronic pain on pain meds for several years may not even provide a little relief.

Thus, as more drug is required, a patient is not ADDICTED. Addiction is when the drug is used improperly, typically for its "feel good" effects. (In other words, used to get stoned, not to relieve pain). If a patient has a medical reason to hurt, and is treated appropriately and takes the drug appropriately, they cannot become addicted. This brings us to the patient problem.

The vast majority of patients who illegally seek drugs are just that -- drug seekers. Instead of buying their fix on the corner, they try to fake their way through the medical establishment. I used to work in emergency rooms to make ends meet, and I would say 80% of patients who came in demanded a pain medicine of their choice, and often with the most ludicrous excuses -- they lost their perscription, they flushed their pills on accident, yada, yada, yada...One evening, I worked a case in an ER with an obvious drug seeker (story did not check out) and the next night worked in a different ER 150 miles away. Sure enough, same couple came in with the same complaints trying to get drugs.

THe bottom line is this -- doctors are forever in the bind that they addict patients, and have the DEA looking over their shoulder ever willing to come down on a doc who is legitimately treating pain.

For those in chronic pain, my suggestion: see a board certified pain specialist. The American Board of Anesthesiology certifies experts in the field of pain management. There are physicians who have gone through the 4 years of anesthesia residency and then have an additional year in pain training. These tireless physicians dedicate their lives each day to their field, and do a superb job of helping all who hurt.

But please do not use words that are incorrect, and I hope all who read this now understand the difference between addiction and tolerance. As usual, the MSM cannot accurately report on anything.

Thanks for listening to this rant...

[WKB]

Doctors and Pharmacist don’t want you to die
but they don’t really want you to get well either.
(Tongue in cheek)

[pnh102]

I don’t see any reason for this guy to be in prison for 30 years.

Meanwhile, murderers, rapists, armed robbers and other real criminals are let out of prison early to make room for these people.

[KoRn]

I think you replied to the wrong person.

[Howe_D_Dewty]

I am retiring to this little community soon.I never would have guessed such an event occurred there.I have no answer for this situation but as the population ages we must find solutions for these questions.

[Mamzelle]

It’s the system’s way of venting hate for doctors.

[Eaker]

Great post.

Thanks,
Eaker

[tacticalogic]

But please do not use words that are incorrect

I agree with the rant, and will add that it doesn't help that the government doesn't help the situation.

Most people don't even realize how oxymoronic it is to call drugs like meth "narcotics".

[deport]

Apparently East Texas has there share of them based upon this article.....

Raids try to find out if pain managers mismanaged meds

By: PAUL S. MARTINEZ, The Enterprise

06/14/2007

Updated 06/14/2007 11:52:30 AM CDT

Post a CommentPrinter-friendly

	Dave Ryan/The Enterprise Maj. Jimmy Singletary, right, talks with Deputy Chief Ron Hobbs, left, outside the Triangle Medical Clinic across from the Gateway Shopping Center. The clinic was one of the raid sites.

Federal and state law enforcement seized hundreds of documents Wednesday to see if there is enough evidence to prosecute several area doctors suspected of doling out prescription drugs without medical justification.

"It's an ongoing investigation. We'll later determine from our analysis of the evidence if prosecution is warranted," Assistant U.S. Attorney Robert Hobbs said.

Two pain management clinics, four pharmacies and one residence were raided under the warrants signed by U.S. Magistrate Keith Giblin.

Raid sites were Triangle Medical Clinic, 3843 Stagg Drive, Beaumont; Northway Medical Clinic, 3737 N. 16th St., Orange; Storm Pharmacy, 3141 College St., Beaumont; Luparello's Corner Pharmacy, 3570 Fannett Road, Beaumont; Lifechek Drug, 3701 Gulfway Drive, Port Arthur; and T&T Pharmacy, 315 N. Main St., Vidor. The residence was located in the 4700 block of Ashdown Lane in Beaumont.

Names of individuals were not released.

"We feel prescription drug abuse is killing as many - if not more - people than crystal meth and cocaine," Jefferson County Sheriff's Department Maj. Jim Singletary said. "Now, we have to prove that."

The regular patients of Triangle Medical Clinic were undeterred by the commotion, still attempting to get their prescriptions.

"That shows how out-of-control the situation has become," Singletary said. "We had news media and law enforcement in front of the store and yet we still had 27 people enter the clinic, looking for prescriptions."

Beaumont police arrested three would-be patients on outstanding warrants, including a 46-year-old Vidor man named in a felony warrant from Missouri.

Tim Chavers, 25, made the 300-mile drive Wednesday morning from Oak Grove, La., to visit the Beaumont clinic.

He said he has suffered unbearable pain since a car accident left him wheelchair-bound in 1999, and when he runs out of the medication prescribed for him by his Louisiana doctor, he comes to Texas.

Chavers had just paid the $110 fee for his prescription at the cash-only clinic minutes before the raid began. He waited outside the clinic for more than six hours, hoping to get his money back.

David Barker, a 57-year-old construction sandblaster, drove in from Baton Rogue, La.

"The doctors (in Louisiana) say the pain is all in my head. I got kin around here who said I could get my medication here," he said as he leaned against the wall next to the clinic's entrance shortly after the raid began.

A neighbor of the Beaumont clinic, which is located in a Gateway strip mall, said she will not miss the clinic.

"We just don't feel safe," said Valerie Johnson, 29, assistant manager at Beaumont Financial Co., a signature loan business.

She has had to call the police at least five times since the clinic opened in February, she said.

"We've seen people out there staggering like drunks, then they bring kids with them," she said. "It's just scary."

Singletary, who leads the county narcotics unit, said problems have occurred ever since pain management clinics began to open.

"The laws are so vague in this area that's it has made it very difficult to do what we need to do for a criminal investigation," Singletary said.

All drugs in the United States fall into Schedule I through V classifications designated by the Drug Enforcement Administration.

Schedule I drugs are illegal narcotics such as cocaine, marijuana and heroin while Schedule V drugs are over-the-counter medications. Schedule II drugs are potent medications such as morphine and Ritalin. Schedule III and IV drugs are the pain medications such Xanax, Lorcet, Soma and oxycontin, drugs prescribed by unscrupulous pain management clinics.

Doctors in Texas are not required to report prescriptions of Schedule III and IV drugs, which means there is no way to track who is getting how much of these drugs. Some patients collect as many prescriptions as they can from a number of doctors, a practice called doctor shopping.

Senate Bill 1879, authored by Tommy Williams, R-The Woodlands, would change drug reporting requirements and now waits on Gov. Rick Perry's desk for his approval.

Three area doctors who ran pain management clinics have had their medical licenses suspended the Texas Medical Board.

Two of them were penalized for prescribing the same "pain cocktail" of Xanax, Lorcet and Soma to every patient they saw without conducting an adequate medical examination, according to the medical board.

paulsmartinez@beaumontenterprise.com

(409) 880-0737

Updated 06/14/2007 11:52:30 AM CDT

©The Beaumont Enterprise 2007

[OldPossum]

My sister told me of a man in her neighborhood who was suffering from terminal cancer who apparently could not get pain relief from the doctor "treating him" went into his backyard, took his shotgun into his mouth, and solved the problem. It was a very messy scene though.

What a shame though that this poor soul was not medicated to the point where he could die slowly and in the presence of his family.

I suppose the stupid doctor thought that giving him large quantities of opiates would cause him to get addicted. I'll bet that a lot of people, especially with intractable pain at the end of life (or perhaps not at the end of life), commit suicide.

[KoRn]

"drug seekers. Instead of buying their fix on the corner, they try to fake their way through the medical establishment."

I honestly don't know why people go through the trouble of doing this. They have to deal with the hassle of waiting to be seen, the cost of visiting a facility to get a prescription, and the cost of the medicine assuming they even get the prescription anyway. Instead of imposing their addiction/habit on the legitimate medical area, they only need to obtain seeds(which is very easy) and grow a certain type of flower. They could have a virtually endless supply of what makes them 'happy' right in their own garden, and they won't have to make it hard on everyone else. Most narcotics are derived from this flower that we often hear about being a problem in Afghanistan, and it will easily grow anywhere in the world.

[KoRn]

"That shows how out-of-control the situation has become," Singletary said. "We had news media and law enforcement in front of the store and yet we still had 27 people enter the clinic, looking for prescriptions."

How stupid this statement is. They are talking about people showing up for a doctor's appointment as if they are junkies showing up at a crackhouse looking for a 'fix'.

[stinkerpot65]

It keeps the DEA employed and prosecutors in high publicity cases. Sending a doctor to prison is a plumb for any ambitious prosecutor.

[neverdem]

Thanks for the text & link.

[cookiedough]

My elderly father has advanced lung cancer, emphysema, and advanced osteoporosis (I hope I spelled all that correctly). He was in extreme pain all the time. His doctor would only prescribe Tylenol!

I called a psychiatrist friend of mine and asked him what to do (he said for Dad to ask for a morphine patch), along with my Dad’s doctor (who would not return my calls) and the hospital’s social worker. Finally, a week and a half later, my Dad’s doctor gave him a low dose morphine patch, which helps a lot more than Tylenol ever did.

Now, in my Dad’s case, the doctor’s do have to worry about respiratory failure, because of the large tumor in his lung and his emphysema. There must be a trade-off between that and quality of life, though.

I think a lot of doctors, based on my vast experiences with them both as a patient and as the parent or daughter of a patient, are afraid to prescribe narcotics, or at least to prescribe them in sufficient doses at which to satisfactorily alleviate severe pain.

When seeking adequate pain relief for myself or a member of my family, I am frequently forced to pull out my “I am a lawyer” card, and it’s the only time I have ever had to play that card.

[Doctor Don]

Your words were very wise and perceptive. I absolutely agree with all you said!

[Doctor Don]

In your case when you pull out your lawyer card, I’d refer you to another doctor. Intimidation will not get you good medical care!

[mysterio]

If someone has life destroying pain, they should have access to whatever drug they need.

[Lazamataz]

You made so much semse that now I hate you.

[cookiedough]

I am subtle, not mean and threatening.

[wardaddy]

I have cervical arthritis and an arthritic sternum from two surgeries and some other chronic pain that I mostly live with.

But when it is too much, I take opioids....there is simply no substitute.

They are like any other drug except they make most folks feel relaxed and fairly happy but...they have can be used repsonsibly for pain....no doubt about it.

like any other drug, willpower and resist abuse.

I don’t drink or use anything else...period and never ever anything like Rush (allegedly)...my avaliability of narcotics is basically unlimited with my maladies...all of which require surgery but I don’t know how anyone short of bone cancer takes the doses we hear about...200mg of Oxycotin in a day...I do not take Oxycotin....I don’t like anything that long lasting...I’d rather have more short term control on my dosage

they are not telling the whole picture on this doc....

there have always been script doctors...in my day it was for quaaludes or amphetamines

acupuncture helps too but sorta hard to walk around like Hellraiser

[wardaddy]

I know folks doing life with no parole for large scale marihuana smuggling...some went in in the late 80s in their early 30s..

drug sentencing in the Feds is plumb crazy

[wardaddy]

Xanax, Lorcet and Soma

that is not a bad cocktail for someone with acute neuro-muscular pain.

carisprodal (soma) which breaks down to Miltown...a sedative....is a great muscle relaxer

xanax relaxes and also has some muscle relaxing properties...valium is better

Loracet is hydrocodone .....a not too shabby mid level narcotic

any mix like that should be seriously observed though by homecare or hospital...not for driving

[neverdem]

they are not telling the whole picture on this doc....

I mainly posted this to show how arbitrary the law can be about treating pain. I remember reading a malpractice case where the doc was sued successfully for not adequately treating pain. Docs are between a rock and a hard place. When they dump the BATF & E, they can do the same with the DEA.

[Ramius]

Good post.

Perhaps you can educate me a little on this. I’ve never quite understood the “abuse” of pain meds. Having been in college in the 80’s I do understand what “getting high” means with regard to various recreational chemistry. ([ahem] Not that I did any of that myself).

Anyway... that was all many years ago. But a couple of years ago I had a health issue that required some surgery (at first without anesthetic which was, in a word, no fun) but ended up on a morphine IV for a couple of days that was... wonderful. When I was getting out of the hospital, the Dr gave me a script for Oxycontin, as he said I should expect some significant pain for a little while as I recovered.

Well, as it turned out, there was some pain but it wasn’t all that bad and I didn’t dive into the Oxycontin. But one day I figured “what the heck” and took some just to see what all the fuss was about.

I was really disappointed. Sure, the pain was taken care of, but there was ~nothing~ in terms of euphoria or any kind of a “high”. I took a fair dose, not a whole lot, but enough that I figure if there was anything to feel I’d have felt it. I ended up throwing out the rest of the script once the event was over.

I really don’t understand why anybody would bother to “abuse” this sort of thing. If you wanna get high, take something that gets you high. But it ain’t this.

Any help here?

[boop]

There is no doctor I know that would deny a dying patient adequate pain medicine. The problem in this story is obviously a "doctor" who didn't know what he was doing. Keeping medical records in a manila envelope is just a small hint of what a fly by night practitioner this guy was. Relieving pain is a good goal. Turning your patients in to mind numbed zombies is not.

Having said that, I absolutely hate drug seekers. They will totally remove any joy you will have in being a doctor. Nothing pisses me off more than being lied to by some lowlife who wants you to give him his "supply" that he then sells to his POS druggie pals.

[robertpaulsen]

"but if a person is dying anyhow"

If a patient qualifies for hospice care, they should get whatever legal drugs make them comfortable. I'm not aware that the patients in this doctor's care were dying -- other than those he killed.

"it seems to me the last thing the doctor should be worried about is whether or not the patient is going to get addicted to the meds."

His patients were abusing the drugs and selling them. That is something to worry about.

[robertpaulsen]

“Chronic Pain Center and Garage Door Company”

[robertpaulsen]

"Sure, the pain was taken care of, but there was ~nothing~ in terms of euphoria or any kind of a “high”."

Oxycontin is a timed released medicine when swallowed whole. You can bypass that by chewing or crushing it to release it all at once.

Purdue Pharmaceuticals is working on a formulation that cancels the effect of the drug if crushed.

[tpaine]

Color me stupid, but if a person is dying anyhow, it seems to me the last thing the doctor should be worried about is whether or not the patient is going to get addicted to the meds.
Ronin

Somewhere someone is always worrying that others are 'abusing' themselves. -

"- The utterly insufferable arrogance of power, and the need for it, is an absolute fact of the human condition. -- Nothing can be done about it. -
Just as the poor shall always be with us, so shall we have these infinitely shrewd imbeciles who live to lay down their version of 'the law' to others."

[P-40]

They could have a virtually endless supply of what makes them 'happy' right in their own garden

That is what is so funny....if these people would go to a good library and check out some books on horticulture, they will find whole sections on plants that come with the caution to not ingest them because they will make you stoned, or hallucinate, etc.

[CholeraJoe]

Excellent rant, gas.

Hang in there, buddy!

[P-40]

Do they know the source of your friend’s pain?

[traviskicks]

“....serving 30 years for drug trafficking,”





Libertarian ping! To be added or removed from my ping list freepmail me or post a message here.

[DreamsofPolycarp]

There is actually a thriving market on ebay for mimosa hostilis root bark, phalaris grass and any number of sources for tryptamines (DMT). You can do a VERY simple acid base extraction (translated, dump your ground up goo in a solution of sodium hydroxide, then a nonpolar solvent, then put in a little muriatic acid and separate the layers... no chemistry knowledge needed), and allow to evaporate, and you have the makings of an INTENSE hallucinogenic experience. Same goes for morning glory seeds, certain kinds of cacti, and various other plants. Further, you can obtain your own hallucinogenic mushroom spores LEGALLY and grow them (ILLEGALLY) in a substrate you prepare from common materials. Again, all this stuff you can buy right off the internet, legally, including (in some states) salvia divinorum, a legal smokable intense hallucinogen.

You can also do poppy seed extractions for opiates, but you need a little more expertise for that.

These are all from legally obtained sources. NOTE: the preparation of these items is EXTREMELY illegal and will land you in jail if you are caught.

I haven't done any of this kind of stuff in 30 years, but it is amazing to see what I thought was "secret" info for a clandestine number of acid cooks is now available to anyone who can find google.