Doctors say new pill law keeps some patients in pain

A month after law took effect, confusion remains about what is legal.

By Brandon Smith-Hebson

Staff Writer

A new law to fight prescription drug abuse has prevented pain patients from receiving the medication they need, according to doctors in Springfield and throughout the state.

Lawmakers and the medical board see a recent hard-line approach to narcotics prescription as a more vigorous fight against drug abuse. But many legitimate pain patients have gone without proper medication.

A month after a new pain meds law went into effect, confusion abounds about what, actually, is legal — possibly because the state medical and pharmacy boards spread incorrect information, doctors assert, shortly after House Bill 93 passed on May 20.

The board has since corrected itself on that matter, and it recognizes that it’s a problem whenever legitimate medication is withheld. But the board’s spokesperson continues to boast that Ohio now has among the strongest narcotics regulation in the country.

“The law came into effect like blitzkrieg,” said Dr. Richard Donnini, who runs a Centerville pain management practice. “The (state medical) board was tasked with implementing this at just lightning speed. ... That left it up to people to make their own interpretations.”

Shortly after the bill passed, Donnini received a visit from two officials tasked with explaining the law — one from the state medical board and one from the state pharmacy board.

Donnini found the meeting unsettling.

“A $2,000-a-day fine for this, a $4,000-a-day fine for that,” Donnini described.

“My head was spinning. .... Whenever you deal with the medical board there’s a certain amount of scariness to it. But this, I’ve never experienced anything like this. Like their intention was to scare.”

And many doctors agree: how the law has been executed has had a chilling effect on all prescription of pain medication.

The law was a response to the growing problem of prescription drug abuse. For four years now, unintentional drug overdose has been the leading cause of unintentional death in Ohio, according to the state department of health. The rate of overdose passed that of auto accidents in 2007.

In several well-documented cases, Ohio doctors have cashed in on the drug trade by not vetting their pain patients.

“But this was like using a nuclear bomb instead of using a sniper team,” said Dr. Andreas Syllaba, who practiced pain medicine in Springfield for 10 years before joining Donnini’s office.

And the medical board began taking a harder line on pain medication before the law passed.

This year so far, citations for prescribing issues have been handed down at four times the rate they were in 2010. The rate of disciplinary actions, which usually result in a doctor’s loss of license, has doubled.

Many physicians are not willing to speak on the record about their concerns, as they fear they will incur more scrutiny from the state board than they normally would. Of nearly 20 doctors asked for comment, only a few were willing.

And patients who receive health benefits from the state are reluctant to be identified in articles. But they will talk.

Some describe many attempts to land an appointment with pain doctors whose offices are swamped with requests from patients whose doctors stopped prescribing pain meds.

These types of patients hang in a precarious balance, said Dr. Owen Ward, a Springfield psychologist. Many of them have tried more expensive treatments, to no avail, to rid themselves of pain.

And when their medication runs out, the return of pain is accompanied by severe withdrawal.

“These people are either going to start killing themselves or they’re going to start getting it off the street,” Ward said.

Ward has been able to coach his own patients through withdrawal, he said, but he has heard of patients committing suicide because they didn’t have that kind of help.

One of Ward’s patients started saving up for an emergency room visit in case his pills ran out.

“They should be able to weed out those kinds of people (who abuse drugs) without slamming everybody,” the patient said through stammers caused by withdrawal. He has had to half and quarter what few pills he has left.

State Sen. David Burke, R-Marysville, a pharmacist who co-authored the bill when he was a state representative, said it was never his intention to limit legitimate access to narcotics.

“When doctors cut patients off, I would say that’s not quality care,” said Burke.

Burke wondered aloud how the bill could be confusing.

Back at Donnini’s informational visit — to add insult to injury — the state board representatives gave him wrong information, Donnini said.

By the doctor’s account, the visitors told him the new law limits each clinic to prescribing only 2,500 doses of narcotics per month. Many doctors who treat pain patients regularly prescribe 5,000-7,000 doses a month or more.

“He said that his supervisor had told him that,” Donnini said. “I looked at the law, and I contested it with them.”

The representatives stood their ground, leaving Donnini’s entire office staff wondering about their future — and the future of their patients.

A few days later, Donnini spoke with a friend who knew what the law meant. The dosage limit didn’t apply to prescriptions, the friend said. It only applied to doses provided directly by the doctor.

When Donnini called the state board with the information, they didn’t believe him, Donnini said.

Several days later, the board wrote an official position aligning itself with that of the lawmakers. But it may have spread flawed information to other doctors in similar meetings.

Speaking through a spokesperson, the board said it wasn’t aware it ever spread misinformation.

“It’s possible for someone to misspeak, or that something wasn’t said clearly,” said Joan Wherle, the board’s spokesperson.

“What may have been thought to have been said in the beginning,” Wherle said, “that’s over, done with. This is what it is now.”

Burke also said he didn’t know about the confusion.

“I find it hard to believe that the state medical or pharmacy board would be that naive on the bill that they were engaged in,” he said.

Dr. Sairam Atluri, a Cincinnati pain doctor, agrees with Donnini in thinking that the law should have emphasized education more than taken the hard line.

Narcotics have “been used indiscriminately,” Atluri said. “The doctors believe that these drugs are the panacea for chronic pain, (and) all the information we have is sponsored by drug companies.”

Most doctors, Atluri said, don’t take a course specifically on prescribing narcotics.

“As it is, either I prescribe to everybody, in good faith, or I won’t prescribe to anybody,” Atluri said. “That’s what the majority of doctors are doing. There is no education in balancing.”

House Bill 93 requires pain management specialists to meet certain educational requirements, but some doctors say it isn’t the kind of education that would teach a doctor how to prescribe narcotics well.

Donnini’s practice was grandfathered into the law as one that already does a good job. But despite this relative immunity from the bureaucracy, Donnini said the atmosphere is disheartening.

“This is what I’ve chosen to do for 20 years of my life, and I’ve loved it,” he said. “But this has just been so stressful.”

Donnini then told a short story that has occurred multiple times in his career, he said.

A woman would come into his office in tears, saying that her husband had just passed away. She would then thank Donnini for giving the man a good quality of life for the 10 or 15 years he treated him.

“This is why I do it,” Donnini said. “But if I could choose right now, I’d quit. If I didn’t have a responsibility to all my office staff...” he trailed off.

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