Pubdate: Tue, 12 Aug 2003
Source: Kentucky Post (KY)
Copyright: 2003 Kentucky Post
Author: Shelly Whitehead
Bookmark: (Methadone)
Bookmark: (Heroin)
Bookmark: (Treatment)


The Kenton County coroner, a respected family doctor and an elected
official, lost his license to prescribe drugs for a year because, he
says, he was following his conscience and writing forbidden
prescriptions for methadone, a drug used to treat heroin and OxyContin
addiction. Legally, family practitioners can write methadone
prescriptions only for pain relief. Even when Dr. David Suetholz
learned he was not allowed to prescribe methadone for his
drug-addicted patients, though, he continued to prescribe the drug for
some of them.

During a Kentucky Board of Medical Licensure inquiry last year,
Suetholz told the board in a written response that his conscience
would not allow him to do otherwise because he thought the addicts
would go back on the street using drugs.

"I will admit I have been prescribing methadone for pain and narcotic
addiction the past few years. Not until March of 2001 was I fully
aware of the DEA (Drug Enforcement Administration) regulations
limiting the use of methadone by primary care physicians, -- "
Suetholz wrote in records filed with the licensing agency last August.
"Enclosed are the names of the individuals I had seen in April of 2001
and their dates of discontinuations. The individuals' names filed in
the (medical licensure board) complaint -- are patients (to whom) I
could not morally discontinue treatment."

That's when the board suspended his prescribing privileges, which were
just restored July 24.

So, Suetholz, a member of the Summit Medical Group based in Taylor
Mill and the Kenton County coroner for 12 years, has paid the price
for his decision to violate federal narcotics laws. Neither
prescribing privileges nor a medical license  or degree are required
to be elected or perform coroner duties in Kentucky.

The physician, a University of Louisville med school graduate who has
had no other disciplinary actions in 28 years of practice, says he did
it because local addicts had nowhere else to turn. The closest
methadone clinics -- at least 30 miles away -- are in Lexington,
Dayton, Ohio, or Lawrenceburg, Ind.

Further, as coroner, he's seen the bodies of the young people who
remain addicted on the street and overdose.

According to the documents on file with the Kentucky Board of Medical
Licensure, Seutholz wrote prescriptions for 36 addicts. The board,
tipped by a grievance filed by the boyfriend of one of the patients,
told him to stop. He did stop for some of the patients -- mostly young
people who came to him because they could not or would not go to a
methadone treatment center.

Some, though, told him they would go back on the street if they could
not receive methadone treatment through him. Suetholz continued to
write prescriptions for and monitor the treatment of those 6 patients.

The Kentucky Board of Medical Licensure confirmed the case, but its
attorney available to comment on it was out of town this week.

Suetholz said in an interview that he felt the patients for whom he
continued to write prescriptions were incapable of treating their
addictions any other way and that he feared they would return to
abusing drugs.

The grievance filed with the state by the patient's friend stated that
Suetholz continued prescribing methadone to treat the woman's
addiction even though the friend said she was selling the methadone on
the street to buy other drugs.

In the middle of a wave of heroin overdose deaths in Northern Kentucky
last winter, Suetholz discussed the area's heroin problem in an
interview with The Post. He did not, at that time, discuss that the
medical licensure board had penalized him for treating addicts with

He did, however, detail his frustration with what he described as a
lack of treatment options for those addicted to heroin and other
similar drugs.

Not only had Suetholz investigated some of those drug-overdose deaths
in his role as Kenton County coroner, he said he had numerous patients
who had sought help with their addictions through his office.

"The problem is how do you treat drug addiction? You're not allowed to
(treat it) as a primary-care physician -- with any medication like
methadone," Suetholz said in last winter's interview.

"The problem here is that there are not enough quality places for
people to go to treat addiction. -- I have seen people with addiction
who come to my office seeking help, and there is no place to send
them. -- And if there is a place to send them, they very often can't
afford to go there anyway."

Suetholz has paid and continues to pay a price for violating the law
in what he says was the interest of his patients. Clearly, though, he
feels physicians and patients would benefit if more treatment options
were available to doctors in private practice.

"Who's really going to talk to you about (drug addiction) if they know
you can't do anything about it," Suetholz said.

"If you have a venereal disease, you go to the doctor because you know
he can help. -- But why talk to your doctor about this if he can't
help you?"

When the licensure board restored Suet-holz's prescribing privileges
July 24, it placed a handful of stipulations on his future prescribing
practices, including requiring a pain management specialist's written
instructions for any prescription he writes for methadone to manage
pain. He also must follow stringent record-keeping requirements on
certain prescriptions he writes.

Suetholz said that, though the 11-month prescription-writing ban did
not severely affect his practice since his medical partners were able
to write prescriptions for his patients, the whole ordeal over the
past two years has taken its toll.

But with the DEA now examining prescriptions he writes for most
painkillers, he has some newfound hesitancies about his practice, he
said. For instance, though he is one of the few local physicians
recently trained to prescribe the new opiate-addiction treatment drug
buprenorphine, he is hesitant actually to begin treating addicts.

"I don't know if I want to mess with it now," Suetholz said. "A lot of
doctors don't want to mess with it. They go to the (buprenorphine
certification training) meeting, but they don't apply for the waiver
because of the hassles involved."

In late 2001, a National Institutes of Health panel recommended that
the federal government ease regulations that prohibited primary care
doctors from prescribing methadone for treatment of addiction in order
to expand availability of treatment.

The practice is currently used in Europe with success, according to
the NIH, and a six-month-long trial conducted by Yale School of
Medicine researchers concluded that physician-administered treatment
could be successful here.

"We know of no other area of medicine where the federal government
intrudes so deeply and coercively into the practice of medicine," said
Dr. Lewis Judd, chairman of the NIH panel, according to the
professional journal Psychiatric News.

Some say there is a good reason why primary care physicians should not
be handed unqualified rights to treat addicts with methadone or any
other drug: They may not understand the games addicts play.

"Even though they are trained physicians who know their patients, they
are not trained in addictionology, and they can get manipulated fairly
easily," said Dr. Earl Siegel, director of the Drug and Poison
Information Center at Children's Hospital Medical Center in Cincinnati.

"Addicts are notorious for being manipulative in many different areas
and making up stories to obtain drugs -- feigning illnesses, reading
the medical journals to obtain drugs. -- So there's the concern in
giving every primary care physician the power to treat addicts --
because of manipulation." 
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