You’ll Never Guess Which State Just Became a Haven for Painkiller Abusers

We do not expect guns and bulletproof vests to be the tools of the pharmacy trade. But Richard Logan is a pharmacist and a sheriff's deputy in Missouri. Through contact with local pharmacies and access to prescription logs, Logan tries to figure out how many prescriptions people get and from where.

When Logan suspects someone of trying to fill a fraudulent prescription, "he has been known to jump from behind the counter and arrest that person on the spot," according to a New York Times article published yesterday.

However dogged his investigation tactics, Logan is fighting a steep uphill battle. Missouri is the only state that doesn't have a prescription drug registry, and according to many, it has become a hotspot for doctor shopping—getting prescriptions from multiple physicians—and prescription drug abuse. 

There were 14,800 painkiller deaths in the United States in 2008, and for every death there are 825 nonmedical prescription painkiller users, according to the Centers for Disease Control and Prevention. Americans take 97 percent of the hydrocodone in the world—global consumption was over 42 tons in 2010.

Depending on the state, these registries allow or compel doctors to check and make sure patients aren't receiving more drugs than medically necessary.

Without this oversight, Logan's job gets more complicated—and more necessary. 

The lack of oversight in Missouri may be attracting dealers and users from other states. However, recent reports and court cases suggest that overly sympathetic, overworked, or negligent physicians also bear the responsibility for the expansion of prescription drug abuse.

In Witchita, Kan., 16 patients of the Schneider Medical Clinic, a practice run by Dr. Stephen Schneider, died in their sleep in a three-year span. All the patients had been prescribed painkillers. Few other doctors in the area accepted Medicaid, so Schneider found himself with a growing number of disabled patients—many had worked with machinery—who claimed to be suffering from chronic pain.

Schneider regularly saw representatives for pharmaceutical companies and told The New Yorker, "pharmaceutical reps came in and enlightened me that it was OK to treat chronic pain because there is no real cure. They had all sorts of studies showing that the long-acting medications were appropriate."

By many accounts, Dr. Schneider genuinely cared about his patients. He believed what they told him about their pain and wanted to help. After all, chronic pain is a reality. According to the Institute of Medicine, 100 million Americans suffer from it.

Though Schneider tried to heed warnings and respond to concerns about patient painkiller abuse and even "fired" patients, the clinic was poorly staffed and struggled to keep track of patient files. He says that when he did cut patients off or deny them prescriptions, they threatened him.

In 2007, Schneider was arrested and later charged with causing the deaths of three people as well as unlawful distribution of a controlled substance. He was found guilty and sentenced to 30 years in prison.

By flagging overprescriptions at the doctor and patient level, a drug registry could have brought attention to Schneider Medical Clinic earlier and saved lives. Since 2008, Kansas has had a program requiring pharmacists to document every controlled substance prescription to determine whether patients are getting drugs from multiple doctors.

In Missouri, many lawmakers support the prescription drug registry, but a small group is blocking it. State Senator Rob Schaaf, who is also a family physician, said he opposes creating a registry because of potential privacy violations. 

There's also concern that provisions punishing doctors in the event their patients die from overdoses criminalizes physicians, said Dr. Steven J. Stack, a chair of the American Medical Association Board of Trustees from 2012 to 2013, who lives and works in Lexington, Ky.

"I believe it will be largely up to the medical community to make changes," he wrote in 2012.

So far, it seems that registries are making a dent in prescription drug use. In states such as Kentucky, New York, and Tennessee, where guidelines are strictest, prescriptions for controlled substances have decreased by 8 percent since the programs have been implemented, according to the Prescription Drug Monitoring Program Center for Excellence.

Until Missouri joins the rest of the country, Richard Logan will continue strapping on his bulletproof vest and going after prescription drug abusers. It likely won't be enough. "I'm only one guy, and for every person we get to, there are probably 100 who we can't," he told the Times. "How many people have to get addicted and die for us to do what everyone else is doing about it?"

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Original article from TakePart