Pubdate: Sun, 12 Mar 2006
Source: Press Journal  (Vero Beach, FL)
Copyright: 2006, The E.W. Scripps Co.
Author: Derek Simmonsen
Bookmark: (Chronic Pain)
Bookmark: (Oxycontin/Oxycodone)


FORT PIERCE - With the conviction of Dr. Asuncion Luyao this week, a
courtroom drama years in the making finally came to a close. Her
arrest four years ago brought the issue of prescription drug abuse to
the forefront on the Treasure Coast and similar cases around the
country have sparked a national debate about pain management among
patients, physicians and law enforcement agencies.

Since then, awareness of drug abuse and the black market for
painkillers, especially OxyContin, has brought changes in how doctors
prescribe narcotics and how detectives try to reduce the problem.
Luyao, 64, was convicted Monday of trafficking in oxycodone,
racketeering and manslaughter in the death of a patient. The Port St.
Lucie physician, whose license has been suspended since her arrest,
could spend the rest of her life in prison when she is sentenced in

The immediate, local impact after Luyao's arrest was tremendous, as
former patients reported that it was nearly impossible to find a
doctor willing to take them.

"As soon as they heard the name Dr. Luyao, they didn't want anything
to do with me," former patient David Gough said in a March 2002 interview.

The aftershocks continued for months. One former patient came to the
sheriff's office on Midway Road begging them for help with his
addiction. The state Department of Children & Families reported 20 to
30 times more calls than usual seeking help for drug abuse in the
month after Luyao's arrest and set up an emergency screening program
to field applicants.

The sheriff's office attributes some of its subsequent progress in
dealing with prescription drug abuse to its drug diversion unit. While
it has been around for a decade, it is only in the last five years
that the unit increased to two full-time detectives from one, said St.
Lucie County Sheriff's Office Lt. Charles Scavuzzo.

Though there was an increase in doctor shopping after Luyao's arrest,
it has become harder for addicts to get painkillers like OxyContin.
Buying the drug on the street has gotten more expensive, with pills
costing about $50 to $75 apiece compared with about $20 a pill when
Luyao was still practicing, Scavuzzo said.

Cooperation has increased in recent years among doctors, pharmacies
and law enforcement, especially in the realm of doctor-shopping. When
an arrest is made by the sheriff's office, that person's name is faxed
to about 100 area doctors and pharmacies to determine if the person
visited them, too, he said.

There have been no other manslaughter cases brought against physicians
on the Treasure Coast since Luyao's arrest and criminal charges
against doctors remain rare. Awareness has spread about prescription
drug abuse, but problems with fraudulent prescriptions and doctor
shopping still persist, Scavuzzo said.

"Unfortunately with the growth of our population, it's still a
continuing problem," he said.

At Lawnwood Regional Medical Center & Heart Institute, the growing
awareness of overdoses linked to OxyContin and other painkillers has
led to a change in hospitaloperations, staff said.

"Physicians have become very cognizant," said Brenda Dupree, director
of emergency services at Lawnwood. "It's even changed the way we
assess for pain."

When trying to gauge discomfort, physicians and nurses keep more
detailed records about the level of pain patients report and the type
of treatment given, with low doses at the start and a gradual step-up
if needed, according to Cheryl Goforth, chief nursing officer at Lawnwood.

New technology has gone hand-in-hand with adding more protections
around narcotics. For instance, computerized work stations at
Lawnwood, St. Lucie Medical Center and Martin Memorial require a nurse
to sign in and record when a narcotic is removed from the hospital
supply, who it is being given to and why, all steps that prevent
someone from stealing or misusing those strong medications.

Emil Varelli, director of pharmacy at Martin Memorial Medical Center,
said there has been a "tightening up" in recent years on how and why
painkillers are used.

Where OxyContin might have been used more frequently in the past for
short-term pain (such as from surgery or an injury), it is now
concentrated more in end-of-life and chronic pain treatment, he said.

"It works wonders for those who have that chronic pain," he said. "In
the wrong hands, it's definitely a drug that's abused."

In the wake of high-profile physician prosecutions in the past five
years, there has been a backlash from patients' rights groups who feel
it has become harder for people with pain to find treatment.

Prosecutions against doctors around the country have made physicians
less likely to want to deal with pain management or prescribe
narcotics, leaving those with legitimate, chronic pain in the lurch,
said Siobhan Reynolds, president of the New York-based advocacy group
Pain Relief Network. This erodes the doctor-patient relationship and
leaves questions to law enforcement that would be better made by
physicians about what is proper treatment for pain, she said.

"What I'm seeing is a panicked medical community and not just in pain
management," said Reynolds. "We have to ask ourselves, 'Is this an OK
way for the government to be behaving towards its citizens?' "

Her group advocates having state medical boards investigate complaints
and discipline physicians rather than having law enforcement involved,
a position also supported by the Baltimore-based consumer group
American Pain Foundation. Pain remains a major problem for people
across the country and finding good doctors willing to aggressively
treat chronic pain is a problem, said Will Rowe, the organization's
executive director.

"It's a public health crisis that not many people know is there," he
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