Doctors are dealing with increasing abuse of prescription painkillers, as addicts find clever ways to obtain drugs by doctor shopping and faking injuries. One in four emergency room visits are related to prescription drug abuse, as nontherapeutic drug-seekers hop between doctors and hospitals. It is difficult for healthcare providers to determine who has legitimate pain and who is seeking drugs, but systems have been implemented to track prescriptions and identify multiple prescribers. Addressing the prescription drug abuse problem requires collaboration between medical, legal and treatment communities.

1. JAY SOWERS • The Lima News
Natalie Marshall, a pharmaceutical intern at Lima Memorial Health System, counts prescription pills Tuesday in the pharmacy.
Pill-popping problem
Doctors deal with more prescription abuse
By HANNAH POTURALSKI manufactured in order to get nar-
hpoturalski@limanews.com cotics,” said Mark Recker, director of COMMON METHODS FOR DRUGS
419-993-2091 pharmacy at Lima Memorial Health
• Patient must be seen right away
System. • Patient comes in after regular hours
LIMA — Addicts are finding clever According to the U.S. Drug Enforce- • Patient says he/she is from out of town
ways to satisfy their needs, with the ment Administration, 25 percent of • Patient feigns physical problems (such as back
abuse of prescription pain relievers drug-related emergency department pain) in order to obtain narcotic drugs
rising at an alarming pace. visits are associated with prescription • Patient feigns psychological problems (such as
One common effort is causing grief drug abuse. These “nontherapeutic anxiety) in order to obtain stimulants or depressants
for health care providers nationwide. drug-seekers” often have a substance • Patient says specific non-narcotic painkillers
Patients jump around to different abuse disorder. don’t work or that he’s allergic to them
doctors, often within the emergency Dr. William Tucker, medical direc- • Patient says he’s unable to get an
department of hospitals, faking tor of emergency services at St. Rita’s appointment with a primary physician
injuries to get a fix. • Patient says a prescription has been lost or
Medical Center, in Lima, said one way stolen and needs to be replaced
“There are patients admitted that to tell if someone is a nontherapeutic
are drug seekers complaining of • Patient pressures the physician by using
sympathy, guilt or direct threats
excessive pain that may be real or See DRUGS • A7

2. DRUG • from A1 –––––––––––––––––––––––––––––––––––––––––
drug-seeker is how this, Baker said, is that pri- ations and detoxification by they’ve ever had access to
acquainted they are with vate practice doctors don’t addiction services to and they can’t do their jobs
painkillers. feel comfortable writing patients perceived as non- without it,” Droz said.
“They usually will ask for prescriptions for narcotics therapeutic drug-seekers. Programs such as OARRS
a certain type of medication and painkillers. He said rarely do patients have been around since
or will manipulate the situ- Christine Clymer, director take advantage of the ser- 1940, and 40 states have
ation to get what they of Lima Memorial Profes- vices offered. Reactions implemented similar pro-
want,” Recker said. sional Corp., a network of vary from patients becom- grams. Droz said there are
Tucker said a local study 11 primary care doctors, ing angry to sheepishly 7,500 registered users in the
showed 52 percent to 70 said they don’t come across admitting there’s a problem OARRS program, with
percent of emergency room a lot of nontherapeutic but still declining the ser- 1,600 physician requests
patients present some form drug-seekers, but it does vices. daily.
of pain. Of that number, 20 happen. “Once in a blue moon, Hospitals and local phar-
percent cite chronic pain “If a patient tries to hop someone will take the help,” macies work hand in hand
problems. He estimated 4 from doctor to doctor, we Tucker said. “Once in a at combating nontherapeu-
percent of the patients visit-inquire why they want to while, we’re wrong, and the tic drug-seekers. Pack said
ing the emergency depart- transfer,” Clymer said. person isn’t addicted.” that, when dealing with a
ment fabricate their pain. “When they realize it’s a Numerous computer pro- questionable patient, he will
Large-scale problem network of doctors, we may grams have been estab- contact the physician to
Eric Wonders, spokesman never see them again.” lished in an effort to track clarify the situation.
for the Ohio Department of Tough call for docs and reduce drug abuse. “They call me all the time
Alcohol and Drug Addiction Baker said it’s hard to use At Lima Memorial Health if they have concerns about
Services, said the prescrip- discretion when it comes to System, there’s a computer a prescription,” Tucker
tion drug abuse trend began treating pain. program that tracks all said. “They do a fantastic
in 2000. “You start to know people usage of controlled sub- job. Recently, a pharmacy
Garrison Courtney, spo- by heart, but you continue stances within the phar- called me because a person
kesman for the U.S. Drug to treat them based on a macy. Recker said there’s pretended to be me.”
Enforcement Administra- screening exam that little problem with employ- When a patient forges a
tion, said prescription pain involves a physical exam ees stealing narcotics, in prescription or poses as a
medicine is the second and questions,” Baker said. part because of an auto- medical official over the
most-abused drug, behind “When we examine a per- matic dispensing storage telephone, Pack calls the
marijuana. son, we have to believe they device that nurses can’t authorities.
“With the Internet, rogue have pain because I can’t access without a code. With more than 30 years
doctors and pharmacy prove otherwise.” “It leaves behind a good of pharmacy work under his
break-ins, it remains an Tucker and Recker paper trail, and the Pandora belt, Pack said he’s seen a
issue,” Courtney said. agreed. System that we use graphs lot of different tricks.
Courtney said there are “It’s a difficult thing for information by nurse and “My favorite is, ‘I dropped
three main sides of prescrip- the health care giver patient, so we can see who’s the pills in the toilet.’ Some
tion drug abuse: an active because either the patient utilizing what and how of the stories are very
treatment community, law does or doesn’t know often,” Recker said. inventive, entertaining and
enforcement and online they’re addicted, and you Tracking drugs have intricate fabrications,
issues. can’t turn them down,” The Ohio Automated Rx and others lack originality,”
To help deal with the Recker said. “Do you try to Reporting System, which Pack said.
online aspect of obtaining intervene or just give them began in 2006, helps physi- A hopeless effort?
prescription drugs, the the medicine?” cians and pharmacists regu- “There’s no quick resolu-
Ryan Haight Online Phar- Tucker said federal regu- late the prescription infor- tion or ‘easy button’ for this
macy Consumer Protection lations by the Joint Com- mation of patients. problem,” Wonders said.
Act of 2008 passed in Octo- mission prohibit the hospi- Danna Droz, administra- “Collaboration and commu-
ber 2008. It works toward tal from not treating a tor of the prescription mon- nication on the national,
reducing the number of patient’s pain. itoring program, said every state and local levels is key
rogue Internet pharmacies “We err on the side of cau- time a prescription for a to bringing about positive
selling prescription drugs. tion because of the chance drug with abusive potential change.”
“We are aggressively pur- of not treating genuine such as oxycodone or Wonders said the Ohio
suing it, but it’s a large pain,” Tucker said. hydrocodone is filled, phar- Department of Alcohol and
issue and will take time,” he Tucker said a patient’s macies are required to Drug Addiction Services
said. “All physicians that pain is evaluated through report it to the Ohio State works with the U.S. Depart-
prescribe pain medications diagnostic testing and Pharmacy Board. ment of Health and Human
are registered through the patient history. The program helps iden- Services, law enforcement
DEA, and we work at edu- “We look for objective evi- tify when a patient has mul- and the Ohio State Phar-
cating them on aspects of dence as to why a pain is tiple sources to obtain a pre- macy Board to find an effec-
abuse and trends.” occurring and also look at scription and how many tive response.
Why the ER? the behaviors demonstrated prescriptions that person Wonders stressed the
Dr. Tammy Baker, med- by the patient,” Tucker has. importance of parents
ical director of emergency said. John Pack, owner of Pack teaching children preven-
services at Lima Memorial Tucker said he’s seen Pharmacy, said the OARRS tion techniques.
Health System, said part of patients with true problems system helps him most Sanford Starr, chief of
the problem stems from become overusers, but he when dealing with patients planning, outcome and
people not having insurance also deals with outright who’ve learned how to use research at the Ohio
or Medicaid. That popula- criminals who fake injuries the system to visit numer- Department of Alcohol and
tion often uses the emer- to obtain controlled sub- ous pharmacies. Drug Addiction Services,
gency department as its pri- stances. Tucker said there’s “It’s a continual struggle, said alongside prevention,
mary physician. a difference between being but that doesn’t mean we officials must be prepared
“For those with chronic addicted to pain medication play the part of forever for what’s next to decrease
pain issues, there’s no pain and being a drug addict. fool,” Pack said. “It’s some- misuse.
management center avail- “Your body becomes phys- thing you develop over the “It doesn’t mean the
able. There’s no other place ically dependent and used years instinctively, and you problem will ever go away,”
to go but the emergency to the drugs; drug-seekers recognize symptoms of drug Starr said. “It’s the drug du
room,” Baker said. feign illness to get drugs for abuse.” jour, and when it decreases
Tucker said chronic pain recreational use or resale,” Droz said the program something else will take its
shouldn’t be managed in Tucker said. saves information for up to place.”
the emergency department Problem solvers two years. You can comment on this
but often is. Tucker said St. Rita’s “Physicians tell us this story at
A reason that supports Medical Center offers evalu- program is the best thing www.limaohio.com.