Pubdate: Sat, 19 Mar 2016
Source: Times-Tribune, The (Scranton PA)
Copyright: 2016
Author: Joseph Kohut


With Region in Grips of Drug, Alcohol Habits, Hearing Looks for Solutions.

The amount wasn't much.

In Florida, Bobby Long's doctor wrote him a prescription in the 
winter of 2013 to take 5 milligrams of oxycodone four times a day to 
curb his sudden neck and arm pain. The patient didn't want to, and 
the doctor didn't want him to. Both knew Mr. Long was seven years 
sober from alcohol and cocaine addiction, but tramadol wasn't 
touching the pain.

Mr. Long took the pills sparingly. But by February 2014, he needed 
discs replaced in his spine and received intravenous pain medication 
and he "loved how it felt."

"That is the day the demon of addiction woke up again," he said.

His story, though perhaps the most personal, was one of several told 
Friday at Geisinger Community Medical Center during a hearing called 
by U.S. Sen. Pat Toomey that examined opiate and opioid addiction - 
and the community's response - so Congress can craft specific policy proposals.

"It is in every county of Pennsylvania, it is in every geographical 
area of Pennsylvania, it is in every demographic," Mr. Toomey said. 
"It's urban, it's suburban, it's rural."

The hearing comes on the heels of a bill drafted by Mr. Toomey, the 
chairman of the Senate Finance Subcommittee on Health Care. The bill 
targets Medicare abuse by preventing beneficiaries from going to 
multiple doctors and pharmacies to obtain and fill prescriptions for 
a large amount of pills, which could be abused or diverted to the 
black market. The bill locks people into a single prescriber and 
pharmacy upon the discovery of evidence of doctor shopping, much like 
what Medicaid and commercial insurers already do.

The problem is significant because the number of opioid-addicted 
seniors has tripled during the last decade. The bill passed the 
Senate earlier this month.

Worst in history

Mr. Long was one of four witnesses called to testify during the 
hearing. The others - Margaret Jarvis, M.D., medical director of the 
Geisinger Health System's Marworth Treatment Center; Lackawanna 
County President Judge Michael J. Barrasse; and Eric A. Wright, 
Pharm. D., a research investigator at Geisinger Health System - each 
shared very different perspectives of the regionalized impact of a 
nationwide crisis.

"The current overdose epidemic is the worst in the history of 
humanity," Judge Barrasse, who heads the county's treatment court, 
said at the hearing Friday. "I've never seen devastation as we see today."

Judge Barrasse stressed that treatment courts should be the 
foundation of a criminal justice system rather than simply as a part 
of it. About 80 percent of people jailed are there for drugs or 
alcohol related crimes. While jail holds them accountable, treatment 
courts can prevent them from relapsing and repeating the pattern.

"We cannot simply lock up the addicts and expect the underlying 
disease to vanish," Judge Barrasse said.

Educating doctors on addiction is key, Dr. Jarvis said. Predicting 
who is vulnerable to addiction is difficult. Programs that curb 
doctor shopping, like Mr. Toomey's bill aims to do with Medicare, 
will help, she said.

"My colleagues and I received little education on addiction in 
medical school and the consequence of that i s what's killing more 
patients than car crashes in this country," Dr. Jarvis said.

'Unholy marriage'

A shift occurred in the late '80s and early '90s when doctors began 
treating pain more aggressively. But at about the same time, 
oxycontin, an addictive opioid, received FDA approval. A lot of money 
went into its marketing. The mixture of good intentions and heavy 
marketing formed "a rather unholy marriage," Dr. Jarvis said.

"That changed things a great deal," Dr. Jarvis said.

During the last 10 years, overdose deaths from prescription drugs 
tripled while the rate at which pain medications are prescribed 
quadrupled, Dr. Wright said. At Geisinger, doctors still prescribe 
opioid pills to manage pain in legitimate cases, but the medications 
are prescribing lower amounts.

Gregory Thomas, D.O., who specializes in orthopedic trauma, said at 
the hearing his practice has changed "100 percent" during the last 
year, reflecting on a statistic that the United States prescribes 80 
percent of the world's narcotics. He now treats patients with a 
minimum amount of opioid medication.

"Everyone's perception ... needs to change," Dr. Thomas said.

Great need

Through more than an hour of testimony, Julian Phillips felt stigmatized.

He agrees that addiction is an issue and that more needs to be done 
to curb it, but he and many other people have legitimate needs for 
opioid medications. While living in London in 1982, he dislocated his 
right ring finger and developed reflex sympathetic dystrophy, a 
chronic pain condition. After more than 20 surgeries, he's had the 
ring finger amputated and any contact with his right arm brings 
excruciating pain. He lives in the Lehigh Valley as the state's 
ambassador to the U.S. Pain Foundation.

"There are people who do need medication and a lot of what you're 
doing is great, but a lot of what you're doing is making me feel like 
a ... drug addict and I'm not," Mr. Phillips said. "You talk about 
medications being an issue, you need to start with alcohol."

Lost all, again

Alcohol began Mr. Long's troubles. He started drinking at 13 and 
turned to other drugs. Cocaine was his "best friend" until he was 30 
and he had a criminal record in every one of the numerous 
jurisdictions he's lived in across t he country. He became sober in 
2007 and built a life.

"I was happy, my family came back to my life, my legal problems were 
solved," Mr. Long said. "I had the greatest friends I could ever ask 
for. I was so full of hope and happiness that it still brings a tear 
to my eye today."

He moved to Naples, Florida, got married and bought a house. He even 
built a "white picket fence" around it.

"I wish my story ended there," Mr. Long said.

When his spine surgery spiraled him into opioid addiction, he drank 
alcohol and consumed cocaine again. In five months, he lost 
everything he built during seven years of sobriety.

On Dec. 30, 2014, he checked himself back into Clearbrook Treatment 
Centers, where he is now a treatment provider in Scranton.

"As much as I wanted to die, I wanted another shot at life a little 
bit more," Mr. Long said.

He acknowledged he has a long road ahead for recovery. He suffers 
from doubt. He has guilt and feels shame. But he also has hope.

"There is a bigger part of me that says I deserve and will have a 
life beyond my wildest dreams again," he said.
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