Have you ever sat down and thought about how many people you know who are addicted to opiates? Have you ever taken the time to sit with them and understand how their addiction began or what took them to the dark place they were or are currently in? “Every day, more than 115 people in the United States die after overdosing on opioids (Opioid Overdose Crisis, 2018)” and “from 1999 to 2016, more than 200,000 people died in the United States from overdoses related to prescription opioids (Opioid Overdose, 2017).” Pain is a feeling people experience due to a plethora of reasons and when the pain gets to be unbearable they make the decision to see a healthcare professional for relief. These healthcare professionals can be seen in a multitude of settings such as a hospital, urgent care, or their medical home, and these are healthcare professional’s people trust in or, so they think.
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Dr. Kofi Shaw-Taylor was a practicing urologist for the past 35 years after attending medical school at the University of Ghana which he completed in 1973. Dr. Shaw-Taylor then went on to do his internship at Sinai Hospital in 1980 and then proceeded onto his residency with the University of Maryland Medical Center in Baltimore city in 1983. Medical doctors make an oath after completing their medical education which states though shall not do any intentional harm onto anyone. “A judge sentenced a urologist who practiced in Anne Arundel to five years in prison Thursday for his role in two “pill mills” that gave patients prescriptions for thousands of doses of powerful and addictive painkillers. Dr. Kofi Shaw-Taylor, 68, was sentenced by Anne Arundel County Circuit Court Judge Michael Wachs to two five-year concurrent sentences after pleading guilty to a charge of Medicaid fraud and another for conspiracy to commit Medicaid fraud (Doctor in painkiller ‘pill mill’ case sentenced to five years, 2018).” The article then goes on to states “Shaw-Taylor said he built a dedicated practice to help his patients manage chronic pain, and his work was a part of his mission as a Christian (Doctor in painkiller ‘pill mill’ case sentenced to five years, 2018).”
How did America get into the opiate crisis we are currently facing? “Prescription opioids are often used to treat chronic and acute pain and, when used appropriately, can be an important component of treatment. However, serious risks are associated with their use, and it is essential to carefully consider the risks of using prescription opioids alongside their benefits. These risks include misuse, opioid use disorder (addiction), overdoses, and death (Opioid Overdose, 2017).” An article states that “in the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. An estimated 4 to 6 percent who misuse prescription opioids transition to heroin (Opioid Overdose Crisis, 2018).” Have you ever through of the lengths you would go through just to be able to survive the next day not in pain? “Patients of Dr. Kofi Shaw-Taylor paid as much as $500 in cash each for prescriptions of large quantities of painkillers and other drugs, including oxycodone, morphine, tramadol and benzodiazepine.” (Doctor in painkiller ‘pill mill’ case sentenced to five years, 2018) “The order also said he prescribed opioid painkillers to patients even if they tested positive for illicit drugs and gave prescriptions to patients after another doctor practicing in the office declined to. Up to 70 patients a day could be waiting to see the doctor, who did not keep regular hours or proper records, the order said.” (Doctor’s license suspended after state board said he over prescribed opioids, 2017)
On a scale from 1-10, 10 being the worst pain ever how bad is your pain? Is pain the fifth vital sign and is it accurate to say pain is whatever the patient states it is? “Approximately 50% of non-medical users of prescription opioids get them from friends or relatives; 25% get them by prescription from physicians. Despite the often-cited problem of patients obtaining prescriptions from multiple prescribers, most receive the prescriptions from one doctor. Fewer than 10% are purchased from drug dealers or other strangers (The Opioid Epidemic: Who Is to Blame?, 2018).” Is it ethical for pharmaceutical companies to promote their drug knowing the harm it potentially holds? “Whether good or bad, pharmaceutical company representatives are sales people trying to get physicians to prescribe their products. The argument that these doctors were misled, then it must be asked how someone who spent 4 years in medical school and at least an additional 3 years in postgraduate training could be so ignorant about opioids (The Opioid Epidemic: Who Is to Blame?, 2018).” It was only about a decade ago that pharmaceutical companies were able to supply their providers with perks such as pens, sweatshirts, bags, dinners, and other forms of “bribery” and promotions. This became an issue when the thought process that these products can cause a healthcare provider to push towards one product vs another which was what put this “bribery” and heavy promotions came to an end. As a healthcare worker I interact with pharmaceutical representatives regularly and have noticed that there is a variety of different sales pitches and extents one will go to in order to push their product. I feel that it is to the healthcare professionals’ discretion to choose the best product for their patient based on the criteria of the patients’ illness and their basic lifestyle. I work with a patient population whom primarily struggle with addiction, therefore a medication that needs to be taken multiple times a day when there is a one pill once a day option would not be the best option due to their lifestyle and the risk for non-compliance. Addiction is not a new concept to anyone and this article goes on to prove that “when doctors say no one could have foreseen that patients prescribed opioids for legitimate pain complaints might end up abusing them, they fail to note that research published more than 25 years ago was already reporting problems with opioid analgesics (The Opioid Epidemic: Who Is to Blame?, 2018).” With the knowledge and promotion known about the opioid addiction how do we now as a medical unit move forward and aide in the wellbeing of those suffering with addiction as well as removing those who are doing harm.
Who is responsible for reporting healthcare professional fraud and does it have an impact on the fraudulence? It is the responsibility of everyone in the healthcare field to report any suspicious activity or known misuse or over prescribing of medications or medical neglect to report y law and ethically. “The board’s order cited complaints against Shaw-Taylor dating to 2015 from hospital officials, a pharmacist, a patient, a patient’s family member and anonymous sources, who found Shaw-Taylor’s actions unprofessional or inappropriate (Doctor’s license suspended after state board said he over prescribed opioids, 2017).” Unfortunately there are a plethora of people who fall into addiction due to a doctor’s negligence, but it is those who see a problem and speak up about the problem, as many did involving the over prescribing and medical negligence of Dr. Kofi Shaw-Taylor. Post the Drug Enforcement Administration’s (DEA) raid in to Dr. Shaw-Taylor’s practices and the shutting down of Westside Medical Group and Starlife there was an alert sent out to the local hospitals, clinics, doctors’ offices, and health departments about the influx of people detoxing off pain medications due to the closing of these practices. This alert was also sent out to enhance people’s knowledge of not only the increase in detox, but the treatment these people should be receiving, whether it is initiated at the facility or the person is recommended to enter into an inpatient/outpatient facility. “More than 17% of Americans had at least one opioid prescription filled, with an average of 3.4 opioid prescriptions dispensed per patient (Opioid Overdose, 2017).” So where can these people go for help and what treatments are available?
Treatment for opioid addiction comes in a variety of sources such as inpatient treatment, outpatient treatment, or a maintenance program such as methadone or suboxone which should be accompanied by online therapy, group therapy, individual therapy. Addiction is a disease as well as a lifestyle for many. The efforts some have gone through in order to maintain their lifestyle and habit to avoid withdrawal is extensive and this is why it is critical that the mental health component be present in the treatment of addiction. The opioid crisis is first and foremost an effort of the individual, but then a team of professionals, and since everyone deserves the best, it is critical we have the resources to supply them with the best available. In addition to the promotion and increase of treatment facilities the DEA has started to put stricter regulations on opiate prescribing as well as pharmacies dispensing. A prescription monitoring system has recently been launches in Maryland called the Chesapeake Regional Information System for our Patients (CRISP). Most healthcare facilities, offering patient treatment, are to be enrolled in this system. CRISP is a regulated and strictly monitored system used for healthcare facilities to share and upload information on patients. One of the greatest services CRISP offers is the strict documentation of where a person picked up a prescription, when, how it was paid, quantity, as well as the prescriber. CRISP has made it possible for the beginning states of “hospital shopping” and utilizing multiple pharmacies to decrease not allowing patients to over indulge in opiates. Over the past few months I have seen multiple insurance companies both, state and commercial, send out letters informing the healthcare providers that people in need of an opiate will on be able to get a small quantity in a specific number of days and in order to receive more a prior authorization would need to be completed and approved for further medications dispensing. Addiction affects everyone involved and “the Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement (Opioid Overdose Crisis, 2018).” With all of these components incorporating stricter guidelines and opening up more lines of treatment and communication we should start to see the economics burden on the United States decrease as well as the American population increase, due to fewer deaths.
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As a healthcare worker in Baltimore City for the past decade I have seen my fair share of the opioid epidemic as well as the devastating opioid addiction is for all involved. One huge factor I have seen in the opioid epidemic is the family pattern, the person with the disease of addiction typically comes from a mother, father, siblings, grandparents, uncles, aunts, etc who also suffer or suffered from addiction. When I grew up I was taught to go to school, get an education, then a job, get married, have some children, and raise a family, but this is not the case for most of the population I encounter. Having spent many years with my patients I have learned the majority of them are not well educated and the majorities come from broken homes full of distrust. People only do as they are taught or know from watching others so, when someone takes the time to invest their medical treatment in a healthcare professional that they trust it can be a huge step for someone and their mental as well as physical wellbeing in addition to possibly saving their life. After finding a healthcare professional they do as they are told per their healthcare professionals’ knowledge. These people trust their healthcare professional is doing what is best for them and should that trust be broken it can become detrimental. In the case of Dr. Shaw-Taylor many lives were disturbed, ruined, and potentially ended which is not fair to anyone who is just seeking medical treatment. The role models and guidance to have a thriving future has decreased and it is truly a sad sight to see. Treatment for addiction is something nobody can force someone into, but has to be a decision made by the addict themselves, but with the DEA enhancing their protocol, insurance companies cracking down on prescriptions being covered, and people like Dr. Shaw-Taylor being put in prison the disease of addiction stands a chance to make a turn around.
“If a child went to school yet was unable to read or perform basic math, we’d blame it on the inadequacy of the education he received. Similarly, if doctors finish medical school and postgraduate programs without adequate knowledge about opiods, it’s the fault of those who taught them (The Opioid Epidemic: Who Is to Blame?, 2018). With “the misuse of an addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl is a serious national crisis that affects public health as well as social and economic welfare (Opioid Overdose Crisis, 2018)” and over 115 people dying everyday of an opiate overdose it is great news to have people such as Dr. Shaw-Taylor running “pill mills” in prison.
References
- Cohn, M. (2017, June 28). Doctor’s license suspended after state board said he over prescribed opioids. Retrieved November 21, 2018, from https://www.baltimoresun.com/health/bs-hs-over-prescribing-opioids-20170628-story.html
- King, S. A., MD, MS. (2018, June 14). The Opioid Epidemic: Who Is to Blame? Retrieved December 15, 2018, from https://www.psychiatrictimes.com/article/opioid-epidemic-who-blame/page/0/1
- National Institute on Drug Abuse. (2018, March 06). Opioid Overdose Crisis. Retrieved November 21, 2018, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
- Opioid Overdose. (2017, August 30). Retrieved December 14, 2018, from https://www.cdc.gov/drugoverdose/data/prescribing.html
- Stewart, J. (2018, August 06). Doctor in painkiller ‘pill mill’ case sentenced to five years. Retrieved November 21, 2018, from https://www.capitalgazette.com/news/for_the_record/ac-cn-shaw-opioid-sentencing-0803-story.html
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