Pubdate: Sun, 13 Jan 2002 Source: Indianapolis Star (IN) Copyright: 2002 Indianapolis Newspapers Inc Contact: http://www.starnews.com/ Details: http://www.mapinc.org/media/210 Author: Gina Barton Bookmark: http://www.mapinc.org/find?186 (Oxycontin) PATIENTS BATTLE PAIN, SUSPICION The arrest of an Indianapolis pain doctor on federal Medicaid fraud charges has put hundreds of patients in crisis, unable to get vital medication and at risk of severe side effects from withdrawal. Dr. Randolph W. Lievertz, who was arrested late last month, is accused of writing dozens of prescriptions for the powerful narcotic OxyContin, which later was sold on the street. One patient also was charged, and Assistant U.S. Attorney Josh J. Minkler said investigators suspect others might have been selling the highly addictive painkiller, which when crushed and ingested by an abuser can produce a high similar to heroin. As a result of the investigation, Lievertz's patients -- court records indicate there might be up to 1,000 -- are battling a cloud of suspicion. Notified recently that Lievertz is out of business, and with prescriptions running out, legitimate patients are finding many pharmacists refusing to refill prescriptions and family doctors reluctant to write them. Patients who get referrals to pain clinics might have to wait weeks for an appointment, which could lead to debilitating side effects -- from nausea to sleeplessness to intense pain -- if they run out of the medication. "They're going to be pretty desperate. They're going to get sick, and they're going to withdraw. . . . I would guess a lot of emergency rooms will be full," said Dr. Douglas Molin of the Marten Center for Complementary Medicine and Pain Management at St. Vincent Hospital. One patient affected is Susan Pisarzewski, 42, who needs a walker to get around her tiny mobile home in Wheatfield. A degenerative back problem and several failed surgeries have left her unable to sit up straight -- most of the time she leans forward, her elbows on her knees. "It feels like someone has taken a spear and jabbed it right into your hip. Then the pain travels down your leg, and it feels like the toes are going to blow off your foot," she said. "It's a crushing, heavy weight, like my back is just going to fall apart." Pisarzewski had been under Lievertz's care for more than four years. She takes 44 pills each day, including OxyContin. But since the physician's arrest, Pisarzewski has had trouble getting her OxyContin. Her pharmacist asked if she was a drug dealer. Her primary care doctor wouldn't help. A nurse practitioner who has cared for her daughter also refused. Finally, she got in to see a new doctor after telling him she needed treatment for a rash. After meeting her in person, he agreed to write her a prescription for morphine so she can avoid withdrawal. But Pisarzewski fears the pain will become overwhelming while she waits for an appointment with a new pain specialist next month. Skip Baker, president of the American Society for Action on Pain, a patient advocacy group in Virginia, said similar scenarios are unfolding nationwide as authorities crack down on illegal OxyContin use. Some pain patients need emergency counseling to prevent them from committing suicide if they are cut off from their medications, he said. "People who haven't been through it have no idea how bad it is," he said. "It's very hard to find doctors who understand this." Molin said people in pain cannot get high from OxyContin because the drug, which has a time-release mechanism, travels to the distressed nerve endings throughout their bodies rather than to their brains. Yet many patients are incorrectly labeled addicts. "Pharmacists look strangely at our patients, and some don't even fill the prescription," he said. "Doctors are that way, too. (They think) if you're taking opiate medication, you're an addict." Dr. Palmer J. MacKie, director of the integrated pain center at Wishard Memorial Hospital, said primary care physicians need to help their patients through the rough transition to finding another pain specialist. MacKie said the family doctors shouldn't let suspicions about addiction scare them into neglecting their patients. "I suspect they are (scared), and they're behaving irresponsibly," he said. "Sure, it's a little bit worrisome, and it may be a bit questionable. But that's all the more reason to get involved and help your patient." It's especially important because many patients face lengthy waits for appointments. At the Wishard pain clinic, there is an eight-week wait for an appointment. The Marten Center is similarly booked. Molin hopes area pain specialists can work out an emergency plan to help Lievertz's former patients. Molin said he's willing to risk writing a few prescriptions to drug abusers if it means he can help people who genuinely are suffering. "If I have two patients, one an addict and one legitimately in pain, I would rather give out two prescriptions than deny the person who is in pain the medication," he said. - --- MAP posted-by: Beth