Area Patients, Physicians Culpable for Drug Abuse Problem

Those trying to eliminate prescription drug abuse in Pickens County, as well as the deaths and injuries that such abuse cause, know that part of the problem is the demand.

People are demanding painkillers for problems that would have been dealt with in other ways previous.

But another part of the problem is the suppliers.

Part of the prescription drug problem in South Carolina is that many physicians feel it's easier to write a prescription than explore other treatment options for their patients.

Area medical personnel discussed the issue at last month's Red Zone Rally, sponsored by the Prescription Drug Abuse Alliance.

Dr. Lori Carnsaw of Liberty said the issue is often one of the time that it takes to write a prescription versus the time it takes “to counsel a patient on non-medical options to treat pain or the problems with addiction and dependence.”

“We don't get paid for time,” she said. “We get paid for seeing patients.”

The prescription drug abuse problem has become a crisis over the last 10 years, Carnsaw said.

“We're under pressure to see more patients, to do a lot more documentation, and yet we don't have the time to sit down and talk to patients,” Carnsaw said.

It's a challenge for family doctors to make that a priority, she said.

“I see probably half as many patients as some other family doctors in other parts of the state,” Carnsaw said. “To really do it right, to sit and talk to patients, we really have to change our healthcare system and recognize that for the best quality and safety, we have to do better.”

Part of the problem is pushy and bullying patients.

“We're American,” Carnsaw said. “We want it fast, we want it now, we want it fixed, we want it done.”

When she was training in the late 90s, the emphasis shifted to treating pain in an under-treated population

“The emphasis was for cancer patients, patients who were dying,” Carnsaw said. “That has grown to a whole group of fibromyalgia patients, patients with knee arthritis, 37-year-olds who weigh 300lbs and have sore knees. What used to be a cancer treatment for the last two months of your life has become a daily treatment for five and six years.

Law enforcement and Behavioral Health Services of Pickens County see the patients who have addictions to prescription drugs, Carnsaw said.

“I see the patients who have dependencies,” she said. “I have patients who are going to pain management and taking 120 Loritabs a month, plus 60-90 Oxycontin a month, then going to work every day, then coming home and taking care of their kids.

“And it only takes a couple of glasses of alcohol and maybe an Ambien to push them to an overdose limit,” Carnsaw continued. “And these are the people who are dying. I've lost patients who did not intentionally overdose, who were not addicts, who were just doing what they thought was best.”

Pharmacist Ronda McWhorter said pharmacists are being forced to become “enforcers of the law.”

“Trying to ensure that patients who need the medication get what they need and those that are going to utilize it for other situations, we try to keep that out of their hands as much as possible,” McWhorter said. “We do appreciate the doctors who back us up, who say, 'Don't fill that.'”

Some pharmacists feel uncomfortable about denying a prescription.

“There's nothing that says we do or do not have to fill a prescription,” McWhorter said. “Many pharmacists will utilize that as a scapegoat. 'We don't have that, go down the street.' Some are more intense – they really want to take care of your health, they want to try to ensure the medications are for legitimate purposes.”

Pharmacists used to be able to take for granted that the prescriptions doctors prescribed were necessary.

“That's not always the case now,” McWhorter said. “We do have pill mills. We have patients getting three-months supplies of hydrocodone. If I'm dispensing you three large bottles of hydrocodone, sent to your home, that's put in a cabinet, how do you know that somebody didn't get 10 pills out of that bottle? How do you know that your prescription of Ambien ... that you don't take any more, that your teenager didn't take a few pills out of it, because you haven't looked at it in over a year?”

Law enforcement agents and school officials on the Red Zone Rally panel said that addictions often begin when the user is a teen, and they often get their pills from the family medicine cabinet.

McWhorter urged people to utilize DEA Drug Take-Back Days to get rid of unneeded or expired drugs safely.

Carnsaw said the average patient uses four prescription pills for an acute pain episode.

“If most people are taking four, they probably have 26 left in their medicine cabinet,” Carnsaw said.

“This is what people are taking to 'pharm parties,' pharmaceutical parties,” she said. “They're put in a bowl like Skittles and people take what they want.”

Carnsaw often sees diverters.

“Older folks on Medicare, who can't afford their diabetes medicine, they can't afford their inhalers,” she said. “They can afford those cheap pain pills and they can divert them. They'll take what they need, a few pills a month and sell the rest to buy their other medicines.”